The Benefits of Psychological Treatment for Chronic Back Pain

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This guest post features Dr. Tali Shenfield, Clinical Psychologist

Recent research has demonstrated that there is more to pain relief than masking pain with medication. The treatment of pain by psychological means is a promising new field of research. Although that research is still in its infancy and research samples are small, there is enough evidence to show that the psychological treatment of pain is not only possible; it is very effective under certain circumstances.

For example, hypnotherapy has demonstrated very positive results with children and adolescents who suffer from gastrointestinal pain. It has also proved effective in areas such as headaches and chronic back pain.

The many varieties of chronic pain have proven costly to the patients and put considerable strain on the health care infrastructure in all developed countries. Finding effective but less costly ways to manage pain can be of considerable value in long term care.

Small scale studies have already shown that cognitive behavior therapy (CBT) as well as relaxation and biofeedback techniques can be efficacious in the treatment of chronic back pain. This is very encouraging because chronic back pain is often non-specific in that a physical cause can not always be found or easily identified. Such non-specific conditions can cause patients great hardships while consuming health care resources without beneficial effect.

Psychological treatment seems to work best as part of a multi-disciplinary approach. When combined with effective medical intervention, psychological treatment has the benefit of adding another tool in the drawer and improving the effectiveness of medication and reducing the strain and difficulty of physical therapy.

Tests have also shown that hypnotherapy and biofeedback are quite effective in alleviating depression that is often associated with chronic pain. This is very beneficial in that depression medications often have serious side effects and cannot be combined with other medication under certain circumstances. This allows for improved treatment for depression while enabling simultaneous pain management through medication.

It has also become more and more apparent that therapies that directly include the patient as much as possible are preferred over those therapies that treat the patient as a malfunctioning machine. It is easier to lift people up when you have their assistance.

This is where psychological treatment enters the picture by providing an avenue for the patient to participate in his or her own healing. Tests have show that cognitive behavioral therapy using Therapeutic Interactive Voice Response (TIVR) combined with positive reinforcement and training in coping skills can have a very beneficial effect over the long term, although short term effects are minimal. TIVR shows promise as a cost effective strategy in long term applications and in preventing relapse.

Nevertheless, the problem with many of these studies is the need to develop—some would say invent—unique criteria of measurement and standards for success or failure. This is necessitated by the unpredictability of the patients and caregivers involved.

The human factor is perhaps the single biggest stumbling block to the direct and successful application of psychological treatment of chronic pain. Tests of the effectiveness of psychological treatment are easily affected by “human elements” such as the patient’s attitudes and beliefs as well as the attitudes and beliefs of therapists, doctors and other health care workers.

It’s very difficult to factor such complexity into objective tests to determine effectiveness. Scientific evaluation operates best in a controlled environment where the various factors of the experiment can be easily managed. Science is objective, but the human mind is subjective. Predictability can vary widely from individual to individual. Attitudes, beliefs and hidden psychological factors can have considerable effect and the same experiments carried out on different groups of people can have greatly varying results.

This is why psychological treatment can only really be addressed statistically. In effect, those performing experiments are running into the age old problem of trying to use the human mind to understand the human mind. There is no natural law that demands that people behave rationally or that they conform to the conditions of a scientific test. While we can model the brain, we cannot model the mind.

Author Bio: Dr. Tali Shenfield holds PhD in Psychology from the University of Toronto and accredited by the College of Psychologists of Ontario and Canadian Psychological Association. Dr. Shenfield is a Clinical Director of Richmond Hill Psychology Center, providing psychological assessments and psychotherapy services.

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