What is the role of a psychiatrist?

Psychiatrists are medically qualified doctors who specialize in mental health problems such as severe depression or anxiety or other mental health problems such as schizophrenia. In chronic pain psychiatrists can assess a person’s difficulties and suggest therapies or treatments to help severe depression, anxiety, psychotic conditions or disorders such as obsessive compulsive disorder.

These treatments may include prescribing different drugs to help change moods and conditions. They may also involve referral to a team of mental health professionals who will use a range of talking therapies in order to offer support while the severity of the depression or condition changes for the better.

Talking therapies

Chronic pain may have an impact on your moods, your life at home or at work, your relationships with your family, your partner, even your doctor. It can be a very distressing and miserable experience, making you feel quite alone and different from other people. You may feel that you have lost a great deal – from fitness to friends to employment. For all these reasons, it can be very helpful to talk about the way the pain is affecting you as a person.

Talking therapies can help you share the ways in which the pain has changed your thoughts, moods and daily life. They can also help you talk through what you feel you have lost in different parts of your life. This can enable you to find ways of coping with the pain and to think about how things could change.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (or CBT) is a talking therapy that can help you understand the links between the five parts of yourself. These five parts, described in the Person-Centred Model in Chapter 1, are:

•   Body symptoms, such as pain

•   Thoughts

•   Moods or emotions

•   Actions or behaviors

•   What is happening in your life situation

In CBT, you work with a therapist who helps you learn more about dealing with moods, such as depression or anxiety. The therapist also shows you different ways to cope with unhelpful thinking patterns and actions.

Research has shown that CBT can be helpful in treating many different mental health problems, including depression, anxiety, panic attacks and post-traumatic stress disorder. CBT can also be used to treat physical health problems, such as chronic pain, and other chronic illnesses, such as heart failure. This is because physical health problems can affect people’s moods and their lives in so many difficult and distressing ways. CBT therapists can help by showing people how to recognize and change unhelpful ways of thinking and behaving. This allows them to be less affected by unhelpful moods and to enjoy life more, even if they still have pain.

Pain management programmes

A pain management programme aims to help people with persistent pain learn skills to cope with life better, despite the pain problems. On a pain management programme, people learn more about:

•   Pain systems and how they work in the body (see Chapter 2)

•   Medicines and better ways to manage them (see Chapter 5)

•   Becoming fitter and more active, and using stretching and strengthening exercises to regain or increase fitness (see Chapter 9)

•   Using pacing of activities to help reduce severe pain levels (see Chapter 8)

•   Setting goals (see Chapter 6)

•   Solving problems (see Chapter 10)

•   Rewarding yourself (see Chapter 7)

•   Maintaining positive changes gained through being fitter and pacing activities (see Chapter 16)

•   Talking through difficulties with others, especially partners and family (see Chapter 13)

•   Managing moods, such as depression, anger and worry or anxiety (see Chapter 14)

•   Using relaxation skills, such as deep breathing or relaxing imagery or sounds, or meditation (see Chapter 12)

The programme will often involve working with other pain sufferers in a group, to learn these skills with support from each other. Group leaders work together as a healthcare team, often called a pain management or pain rehabilitation team. The programme may run over several weeks, and the number and length of sessions can vary between different pain management teams. It is a bit like going on a part-time course to learn to manage your pain better. Many people with chronic pain have found these programmes very helpful.

ONE GRADUATE OF A PAIN MANAGEMENT PROGRAMME SAID:

I was able to move forward and learn to cope and accept my pain. The group support from other pain sufferers, who knew what it was like to deal with the pain, made a big difference. They really understood and offered different ways and ideas to deal with problems. It helped my family, as they realized that more activities were possible if I paced myself better. My frustration lessened and I was able to laugh again a bit more often.

After a pain management programme, you might expect to be able to:

•   Take up new activities

•   Start a study or computer course

•   Start voluntary work for a few hours each week

•   Return to work, often through special schemes that are available locally

WOULD A PAIN MANAGEMENT PROGRAMME HELP ME?

Asking yourself some questions may help you decide:

•   Would I like to be more active or become fitter?

•   Do I have problems pacing my day-to-day activities?

•   Do I feel stiff and tense in different parts of my body?

•   Do I have mood changes, such as depression, anger, anxiety or stress, because of the pain?

•   Would it help to know more about pain systems in the body?

•   Do I want to use my pain-relief medicines better or reduce them?

•   Would I value working in a group with other pain sufferers to learn how to manage better?

If you answered ‘Yes’ to two or more of the above questions, then a pain management programme may well be helpful. In order to be referred on to a pain management programme, you will need an assessment. If you already have contact with a health professional who specializes in pain, the first step would be to discuss local pain management programmes with them. Otherwise, you can begin by discussing your needs with your GP or family doctor and ask for a referral to a pain management team.

Alternatively, you could make contact with local self-help pain management groups or access information from the web-sites in the Useful Information section at the back of this book.

CHAPTER SUMMARY

•   Pain can affect all five parts of a person: their life situation, their moods, their thinking, their behavior and their body symptoms.

•   A range of different healthcare professionals can offer advice and support to help people manage life better despite the pain.

•   Talking therapies can offer a chance to talk through life changes resulting from pain as well as ways of coping with pain and its effects on moods, thoughts, actions and life situation.

•   Pain management programmes are a useful way to learn more about chronic pain and how to cope better. These programmes involve working with a group of pain sufferers to gain these skills. Support is provided by other pain sufferers in the group and by healthcare staff.

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