Chronic Pain: Treating the Whole Person

Treating the suffering of chronic pain can be one of most challenging and vexing of all health related problems. Pain is the most common reason for a physician consultation in the U.S., and it has been estimated that 30 million people experience chronic or recurrent pain conditions – defined as pain that lasts for longer than three months or after the tissue damage initially associated with the pain has healed. This perhaps is one of the places where the phenomenon of chronic pain begins its confounding stature: why should pain persist after the damage has apparently healed? While there have been a number of theories proposed at the neurological level for this, what patients experience is that if the pain persists, then treatment may become a sometimes frustrating search for a treatment that targets the symptom but not necessarily the underlying cause which may remain elusive.

Depending on the type of pain, opioids, anti-depressants, steroid injections or even surgery may be prescribed. In some cases these work well, in others repeated and even long-term treatment is the result. In either case, the toll on the patient and on the patient’s family can be tremendous. Chronic pain can result in significant physical impairment and emotional distress, loss of work, family distress, and subjective feelings of an overall diminished quality of life.

Because of this, the most recent research has shown that simply addressing symptom reduction is an inadequate goal in itself. The reality is that, sadly, the treatment of chronic pain, even in successful cases, often means an improvement in but not the full elimination of symptoms. Rather, treatment teams may focus on the physical, emotional and social aspects of a patient’s life and experience as it is impacted by chronic pain. What patients will often report is that these three areas of their life are actually found to strongly impact one another. For example, a reduction in depression that is often associated with pain also reduces the pain itself.  Improved social relationships also serve to improve mood, and through that, the experience of pain. Chronic pain takes away a person’s sense of control over their life. It makes one feel bound to their body and unable to participate in social and physical activities that a person previously enjoyed. But while it is true that in many cases there is no “cure” for chronic pain, patients can learn to retake control and to lessen the constraint that pain has on their lives.


As a psychologist, my job is to help my patients think of themselves not just as a set of pain symptoms to be treated, but as a whole person who is in pain. The change in perception between these two ways of being opens up possibilities that at first are often hidden to the person struggling and in pain. I talk to my patients about what does healing mean to them. Sometimes it may mean full remission, but even when it doesn’t, important questions remain about how a person with long-term pain lives and relates to his or her family, friends, and loved ones; how that person relates to his or her own body and emotional self; and all in all, how that person works, lives, loves and plays – in control of, not controlled by their symptoms.

I am a Licensed Psychologist. Many of my patients are older, and while illness is not necessarily linked to aging, some of my patients also suffer from chronic pain and other physical ailments. My office is in Conshohocken and I can be reached at (484) 534-8830 or at dan.livney@gmail.com. For more information please go to www.danlivney.com

Our Bodies, Not Ourselves?

The popular book on women’s reproductive health, Our Bodies, Ourselves was published quietly in 1971, and quickly became a best seller, claiming no fewer than 9 domestic and 26 foreign editions. The book sought to encourage women to get in touch with the sexual and reproductive parts of themselves; parts that in that era, and perhaps still now, are, as the book points out, often more unfamiliar to women than other parts of themselves.

The important message of this book came to my mind recently because it seems to me to raise some interesting questions about our relationships to our bodies – and when I say “our,” I speak of men and women both. Let me start with the possibly odd-sounding suggestion that our bodies are not ourselves. True, legally speaking, if you commit a crime they will take a mug shot of you. That photo is intended to identify you, the person who committed the crime, and so from a legal standpoint we and our bodies are one. On the other hand, if you think about the point of the book: that we can go through life not knowing about our own basic feelings and biologies, then perhaps we can also say that “we” – let’s for the sake of simplicity call this entity our minds – our minds are in a constant state of relationship with our bodies. We learn about them, we discover them, we enjoy them when they give us pleasure, and we lament them when they give us pain. It is also true that our minds are in a special kind of relationship with our bodies, different than the kind of relationship we have with other people – precisely because our bodies are always there. But still, just because our minds and our bodies are not one and the same, it is also possible for us to have quite complicated relationships with them.

Let me give you some examples of what I mean. When our bodies give us pain, we actually have a range of emotions and options with which we can react. We can tense up, angry that the pain is there. This often leads to more tension and therefore more pain. Or we can relax and accept, and the pain becomes more tolerable. We can make decisions about the pain: how do we know to enjoy the pain of a strenuous workout, but not the pain of a toothache? It turns out these are not simple decisions. For some people the idea of pain from a workout can be just as painful as a toothache and may be part of why it is so hard for many of us to start an exercise routine. That is also an example of our mind making a decision or a judgment about the feelings our bodies are giving us.

Now what happens when our bodies are sick? Let’s use for our example just an everyday cold. For some people that can be quite stressful, others take it in stride. What’s the difference? Maybe just in personality type, but maybe also in the difference between someone who has sick days they can enjoy (and the kind of job where taking them is minimally intrusive), while for someone else it may mean lost wages and complicated child care arrangements. In both cases what we often find is that the ways our bodies react to illness (or pain) is in part based on all of these thoughts and feelings which our minds have about what is going on with our bodies. Depending on what we think, the pain in our body can feel worse, the illness can feel more oppressive.

Most importantly, this means that our way to health, or at least improvement, is also affected by the thoughts and feelings our minds produce about the experiences of our bodies. The same kinds of injuries or illness conditions in two different people – or even in the same person under different circumstances, can have wildly different outcomes. One researcher found that back surgery done to relieve chronic lower back pain is predominantly unsuccessful for people with a history of abuse and trauma in their lives; while the exact same type of surgery is far more likely to eliminate pain in people without such a history.

Next time you are sick, or under stress, or even when you’re not, take heed of the messages your mind is having about your body. As it turns out, an important part of taking care of our bodies involves getting to know our minds, and most importantly, nourishing the relationship between them.

I am a Licensed Psychologist who works with people who suffer from medical conditions and chronic pain. My office is in Conshohocken and I can be reached at (484) 534-8830. For more information please go to www.danlivney.com

Psychology and Medical Illness

A few years ago I was at a reception held at a restaurant, and I was sitting with some friends, several of whom were also psychologists. A husband of one approached, himself an educator, and seeing all of us therapists sitting together joked: “Someone just ate some of the soup and now she’s feeling sick… is there a doctor in the house?” To which, the table's resident smart alec quipped: “Not the useful kind.”

It was a good joke, and we all laughed. Of course, what he had meant was that none of us at that table had been trained in medicine and physiology, and we were not going to the ones best able to help this hypothetical person in that moment. When someone needs to get rushed to the ER, you don’t call a psychotherapist. So what is therapy good for? Is it, as some have asked me, “just talk?” Well, it can be. For some people just talking is something that can be useful in many ways and for many of life’s problems, as some of you already no doubt know or have some personal experience with. But what about when it comes to your health? If most people will agree that talk therapy can help with all kinds of relationship and emotional difficulties, what about when we’re sick or just worried about our health, or that of a loved one? Is it “useful” then?

A great deal of research says, “yes.” Studies have shown that depression and/or anxiety often accompanies major illnesses. This may not seem so surprising. When patients come down with the debilitating effects of conditions such as diabetes, coronary artery disease, cancer or COPD, it raises all kinds of difficult questions about the quality and the length of their lives. People who have these conditions often have to make adjustments to their lifestyles and their day to day activities in response to their symptoms. Major depression can play a role in decreasing their ability to make these adaptations, which leads to further impairment, and so, cyclically, to further depression. Certain illnesses can even mimic, or cause, symptoms of depression or anxiety; for instance, hypo- and hyperthyroidism, some forms of hepatitis, Alzheimer’s and Lyme disease.

But while depression can be the result of a feared diagnosis, it can also contribute to developing various medical conditions in the first place, and in can do so in a number of ways. People who are depressed are more prone to engage in a wide range of behaviors associated with medical illness such as smoking, excessive drinking, or having sedentary lifestyles. Depression can also result in nonadherence to prescribed medication regimens, and to diminished social functioning…all of which can frequently cycle into more depression.

Finally, depression and anxiety are strongly associated with stress, in all of the many complicated ways that modern life is heir to.  Physicians call this condition, “allostatic load,” which is just a way of saying that stress, when it occurs not just in brief periods but when it’s prolonged over the long term, causes all kinds of wear and tear on the body, such as impaired immunity, atherosclerosis, obesity, bone demineralization, and atrophy of nerve cells in the brain. Lastly, data also shows that when people are matched for similar medical conditions, but one group has depressive symptoms and one group does not; the depressed group incurred significantly higher medical costs to treat the exact same condition ($4,246 vs. $2,371 per year according to one study).


Now this really can change the answer to the question “what is the use of talk therapy?”

I am a Licensed Psychologist. Many of my patients are older adults, and while illness is not necessarily linked to aging, some of my patients also suffer from chronic pain and other physical ailments. My office is in Conshohocken and I can be reached at (484) 534-8830 or at dan.livney@gmail.com. For more information please go to www.danlivney.com