Multi-modal Treatment

Drugs, injections and even surgery can be used to directly attack the pain side of the pain-fear equation and should therefore not be ignored despite their potential for short or long term side effects. In fact any treatment that can provide sustained pain relief may be useful if it facilitates reducing the fear of pain. Professional skill and knowledge of chronic pain are obvious requirements for appropriate use of any intervention.

Physical fitness also plays an important role in weakening the bond between pain and fear. Stress responses tend to be reduced the fitter one is. Improving strength, flexibility and endurance enhances performance. Training in posture and body mechanics may reduce physical/mechanical factors contributing to pain.

I believe it is crucial that the pain-fear connection must be taken into account in treating chronic pain, . Physical therapy and work hardening programs may fail if the patient’s fear of physical activity is not reduced and if exercises produce too much pain. Fear would simply be reinforced in this case, thereby making pain worse. In addition people with chronic pain are often subject to serious life stresses including loss of income, family conflict, litigation and worker’s compensation disputes that result from their condition. Such stressors contribute to the pain-fear cycle by adding to the already high stress levels caused by pain. Clearly, any approach to chronic pain should include ways of addressing stress in general.

More than 30 years of studying and practicing psychology and medicine have convinced me that the best way to manage stress is to take on the task of learning to do this oneself. I often tell my patients that all I can do is prescribe drugs, perform injections, refer for other treatments and teach. The rest is up to them. Meditation, relaxation training, visualization and exercise are what one must learn and practice diligently to have an effect on the physiological and neurological processes we call stress. This may be simple in theory but it is difficult in practice especially when so many treatments are marketed that require seemingly little effort.

It is very important to understand that chronic pain requires chronic treatment. However, if the fear of pain can be eliminated or permanently reduced through the use of mind-body approaches, it is possible that the need for some treatments(e.g. drugs, psychotherapy, physiotherapy) may also be reduced permanently. The good news about learning mind body techniques is that they may free you from depending on treatment provided by others. The bad news is that you have to learn and practice almost daily if you are to achieve any benefit.

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