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
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
