Austin, Texas — The pain psychology segment of the American Pain Society’s 35th Annual Meeting, aimed to present psychological aspects of pain care and pain management to non-psychologists.
Mark Jensen, PhD of the University of Washington, whose research focus is on the use of hypnosis for the management of pain, discussed the field of psychosocial intervention for the treatment of pain1. He pointed to the diversity of psychological interventions that are available, most of which he said are supported by solid evidence. He pointed to cognitive behavioral therapy (CBT), which represents, “if not the gold, at least the silver standard of psychosocial intervention”.
The rationale behind those treatments is to modify the way people think about pain since it is a critical factor in how they respond to pain, and influences pain intensity as well as physical functioning. The goal of such treatments is to develop interventions which will help people change how they think about their pain and how they cope with it. Dr Jensen noted that such evidence has accumulated over the past few decades, supporting the efficacy of these treatments for having moderate effects on pain intensity, psychological and physical functioning. There is also acceptance of mindfulness-based cognitive therapies which have a slightly different focus, he added.
“The goal with these interventions is to help patients let go of the struggle against pain, to stop fighting the pain, and instead, to move toward life’s valued activities, and understand the pain context.” he said.
Psychosocial interventions include acceptance behavioral therapy, contextual behavioral therapy and mindfulness-based cognitive therapy, all of which aim to teach people some practices to help them become more mindful, to more easily slip into states which are more accepting, and to facilitate acceptance of pain as well as their engagement in more valued activities.
“When people do this, pain intensity drops, and they experience improvements both in their physical and psychological functioning,” he said.
Dr Jensen’s main interest is in training patients in self-hypnosis. Through this method, he seeks to teach patients with pain to enter into a brain state in which they are more open to useful ideas, and are able to “provide those ideas to themselves – through self-suggestion or by getting suggestions from other people.”
Depending on the content of those suggestions, patients with pain can target how they can effectively process pain information, or change their beliefs about pain and/or their beliefs about their functioning. He explained that evidence for the efficacy of these treatments is strong, and these interventions are more effective than standard care, physical therapy, and medication management.
Dr Jensen also referred to a series of studies looking at hypnosis in conjunction with other treatments such as CBT, and indicating that addition of hypnosis to conventional intervention renders people more receptive and responsive to treatments. These approaches, which help people change how they think about, how they respond to, and how they view their relationship with their pain, can be contrasted to analgesic medication for which the goal is to target pain intensity and sensory information processing in the peripheral and central nervous systems. Dr Jensen said “there is no such thing as a pain-killer, perhaps there are such things as pain-relievers…somewhat. Average pain reduction with our strongest pain analgesic is about 32%, and the median response rate of these medications for people with neuropathic pain is about 35%.”
He and his group investigated adverse events associated with hypnosis treatment. Their studies indicate reports by patients of pain reduction, of an enhanced sense of control over pain, and a sense of having a tool to be able to manage their pain. Study participants also reported an increased sense of well-being and of relaxation as well as decreased levels of stress. The worst reported effect of undergoing self-hypnosis – and that was the case for one person in their study – was the lack of effect. Another individual did not find the method to be as effective as they had hoped it would be; yet another said the effects did not last as long as they had hoped they would.
“So you could imagine for a moment a drug that produces substantial reduction of pain in subgroups of patients with chronic refractory pain, whose side effects are overwhelmingly positive, including a general sense of well-being, and a sense of control over pain, and whose worst side effects are very rare, but the very worst, is that very occasionally, the intervention does not work, and which patients continue to use [which is the case for 80% of his study’s participants]” Dr Jensen noted, continuing: “if you had that drug, you would be a billionaire, and it would be the first-line treatment offered to patients.” But he said “there aren’t that many people pushing these self-control, self-management studies, even though we know they work.”
There is a large variety of psychosocial interventions to choose from (including self-hypnosis), with strong evidence to support their efficacy and which are associated with significant positive side effects. These interventions have the potential to modify one of three aspects of pain: how people think about their pain; their relationship to their thoughts or cognitive processes; how they respond behaviorally. “We know there are changes in one of these things: people can make improvements in their pain intensity, their psychological functioning and their physical functioning”, explained Dr Jensen. And in the model they are studying, these three aspects have the ability to influence each other. His group is studying how different psychosocial interventions may have similar underlying mechanisms. But for Jensen, the bottom line is: “anything that alters how people think or what they think, or their behavior, can influence pain outcomes, and these psychosocial interventions impact those areas […]. We may be able to switch from looking at whether these treatments are effective, to understanding their underlying mechanisms, so that we can better manage patients and treatments”, adds Jensen. “If you ask yourself the question: ‘which psychosocial pain intervention is most effective?’ The answer appears to be: ‘none. Many are effective’, he continues, “and we are looking at doing better treatment managing.”
“But in the meantime, as we understand more about mechanisms, given the efficacy of these treatments, and their side effect profile, we should be looking into ways to help patients gain more access sooner rather than later” concluded Dr Jensen.
1. Jensen MP. Psychosocial interventions for the treatment of pain. Presented at: 35th Annual Scientific Meeting of the American Pain Society; May 11-14, 2016; Austin, Texas.