Dr. Ann Gamsa, director of psychological services at the MUHC (McGill University Health Centre) Pain Centre in Montreal, believes sufferers can learn to modify their pain by using a variety of mental strategies.
While pharmaceutical giants seek powerful analgesics to diminish the anguish of chronic pain, psychologists are augmenting those treatments with the power of the patient's own mind.
The football player who muscles through the last quarter with a broken foot, the soldier who knows he has been hurt but keeps fighting – these real-life phenomena intrigue psychologists.
Though just a few decades ago psychoanalysts thought chronic pain was fulfilling a psychological need in the patient – an individual who felt neglected as a child would use pain to get attention – now the gold standard in treatment takes a "cognitive behavioural" approach, Gamsa explains.
Psychologists realize that the brain has enormous power to influence the level of suffering, she says. In the treatment of pain, distraction can be a very useful tool, she says.
"Because an athlete who completes the game despite an injury is so mentally focused on the activity there is just no room for pain messages to register," Gamsa says.
Cridland has learned how to tap into those same distraction or disassociation techniques. So has the Buddhist monk who teaches himself certain meditations that block pain.
Distraction therapies place patients in a situation in which they are intensely absorbed by another activity. "It doesn't take away the pain. It simply puts it in the background," Gamsa says.
"That's why pain feels worse at night," she says. "It's because there are no other distractions. At night pain sufferers have nothing else on their mental screens," so the pain seems more intense.
"We've also learned that a person's expectations and fears contribute to the total experience of pain," she says.
Three months ago Gamsa practised what she preaches. With the help of "mindfulness" meditation, she endured a dental procedure, the filling of a cavity on each side of her mouth, without freezing. She qualifies, "it was not an extraction. They were not deep cavities and it didn't go on for a long time."
Still, the potential for a shock of pain lurked behind every probe and every whir of the drill.
But she was able to detach herself from the anxiety she would normally feel. "I visualized the pain, where it was in my body, how it felt, what it was shaped like, what texture it had."
Pain specialists try to assess psychological issues that may influence how the patient experiences pain. "They may be depressed, anxious or angry," says Gamsa.
Moods, memory and worries about the future influence the experience of chronic pain.
Just as people who catastrophize pain (imagine that it will never get better) make it worse, those who learn how to manage pain can lessen their suffering.
"We know anxiety can be reduced with therapy: relaxation, meditation, visualization and hypnosis," explains Gamsa.
Gamsa, who runs a pain management group for patients as part of her work with the MUHC Pain Centre, confirms that such mindfulness techniques can make pain more tolerable.
"If you cut yourself, you feel pain. And if you squeeze lemon juice into the wound, the pain intensifies. Stress is like that lemon juice," she says.
During those therapies the pain lessens but often returns when the session is over. So therapists teach pain sufferers how to use the relaxation techniques at home, says Gamsa, who stresses that these techniques do not eliminate pain. |
