Nonpharmacological Pain Management
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counselor Education
Host: Counselor Toolbox Podcast
Objectives
~ Types of pain
~ Impact of pain on sleep, HPA-Axis and mood
~ Treatment options for chronic pain
~ CBT Interventions
Types and Locations of Pain
~ Chronic pain
~ Lasts more than 3 months
~ May have a known or unknown cause
~ Persists beyond expected healing time or despite treatment
~ Best conceptualized as a condition to be managed rather than cured
Types of Pain
~ Nocioceptive Pain
~ Pain that is caused by damage to body tissue and is based on input by specialized nerves called nociceptors
~ Most nociceptive pain is musculoskeletal, and is often described as aching or deep
~ Examples
~ Back and neck pain
~ Arthritis/Gout
~ Tendonitis
~ Bursitis
~ Pelvic floor disorders
Types of Pain
~ Neuropathic Pain
~ Occurs when there is nerve damage that typically involves either the peripheral or central nerves
~ It is often described as burning, shooting, tingling, or electric
~ Examples
~ Radicular pain—radiates along a nerve (sciatica)
~ Phantom limb
~ Fibromyalgia
~ Peripheral neuropathy
~ Spinal tap/epidural
~ Carpal tunnel
Types of Pain
~ Headache Pain
~ Tension (15 days/month for at least 6 months)
~ Cluster (15-180 minutes every other day to 8x/day)
~ Migraine (2-72 hours)
~ TBI (may last 6 or more months)
~ Cervicogenic (referred pain from the neck/cervical spondylosis or fracture)
~ Medication Overuse/Rebound Headaches
Treatment Options
~ TENS units
~ Massage
~ Physical Therapy
~ Stretching
~ Ergonomics
~ Heat/cold
~ Chiropractics
~ Acupuncture/Acupressure
~ Yoga/Tai-Chi
Treatment Options
~ Biofeedback: Noticing HPA-Axis activation and responding with relaxation exercises
~ Relaxation Training
~ Mindfulness
~ Behavioral Therapy. Observable behaviors such as grimacing, sighing, or limping are often socially reinforced and can lead to increased self-perceptions of pain
~ Cognitive Behavioral Therapy (CBT) addresses thoughts, behaviors and emotions associated with pain
~ Acceptance and Commitment Therapy (ACT) aims to develop greater psychological flexibility and learn to “live in the and.”
~ Hypnotherapy
CBT-CP Theoretical Components
Factors Maintaining Pain
Psychological Factors Associated with Pain
~ Pain Cognitions. Negative cognitions and beliefs about pain can lead to maladaptive coping, exacerbation of pain, increased suffering, and greater disability
~ Catastrophizing. Catastrophic thoughts contribute to increased pain intensity, distress, and failure to utilize adaptive coping techniques. Examples “my pain will never stop” or “nothing can be done to improve my pain.”
~ Hurt versus Harm. When pain is interpreted as evidence of further damage to tissue rather than an ongoing stable problem that may improve, individuals with chronic pain will report higher pain intensity regardless of whether damage is occurring (Smith, Gracely, & Safer, 1998).
Psychological Factors Associated with Pain
~ Negative Affect. The relationship between pain and negative affect is complex and bidirectional.
~ Answer-Seeking. Failing to accept the offered cause of pain or being unwilling to accept that a source of pain cannot be determined can lead to increased distress and pain intensity
~ Pain Self-efficacy is the level of confidence that some degree of control can be exerted over the pain.
Social Factors Associated with Pain
~ Solicitous significant other who is highly responsive to an individual’s pain or to expressions of behavior indicativ