Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

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The last couple of weeks we have heard a lot about telephones: Those iPhone electrocutions, and the insidiously increasing incursion into the smartphone market by Chinese companies whose names many of us find difficult to pronounce, and whose profits do nothing for our economy. Why, it all makes you want to crawl into a phone booth to escape the cruelty of the technology.

But maybe there is still some good to be had from that omnipresent device. Ask the chronic pain patient who has benefited from talk therapy via the telephone.

Chronic pain may affect more than 20% of the population in this country, and while there are drugs specifically approved for chronic pain—not to mention the use of (questionably beneficial) narcotic medications for chronic pain—many patients continue with chronic pain. Cognitive-behavioral therapy has proven helpful in managing chronic pain; however, for many patients it is costly, or unrealistic as a chronic therapy due to a relative shortage of therapists.

Cognitive-behavioral therapy allows the recognition of the buried and not-so-buried thoughts and attitudes that can haunt many a chronic pain patient; steps can then be taken to make positive negative thoughts. Alas, in this economy, it might be a challenge for some to glean positivity from a session that could cost a couple hundred dollars for an hour.

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A study published a couple of years ago in the journal “Archives of Internal Medicine” discussed what happened to almost 450 fibromyalgia patients who were assigned to either receive standard medical therapy, telephone-based cognitive therapy, exercise in addition to standard therapy, or all three of the aforementioned. Study subjects were asked before the study and after the duration of a given intervention how they fared in terms of general health, perceived pain levels, and quality of life. Only about 8% of the standard treatment group reported improvement at the end of the study; about 25% of the subjects who also received the telephone-based cognitive therapy reported feeling better; approximately 33% of subjects who exercised at least two days a week in addition to standard therapy reported improvements; and 37% of the subjects who underwent the phone therapy and the exercise program and the standard medical therapy felt either much better—or very much better—at the study’s termination.

Unfortunately, while well-being was experienced with the addition of the phone psychology, these improvements were mostly confined to fatigue and coping. Specific pain symptoms continued.

While no one wants to say it, it appears with chronic pain interventions we always arrive at that awkward place, populated by improvement and management, but never the elimination of pain.

Still, chronic pain patients should not list themselves on psychotherapy’s do-not-call list. As Camus wrote in The Fall: “Don’t think for a minute that your friends will telephone you every evening, as they ought to, in order to find out if this doesn’t happen to be the evening when you are deciding to commit suicide, or simply whether you don’t need company, whether you are not in a mood to go out. No, don’t worry, they’ll ring up the evening you are not alone, when life is beautiful.”

Crawl out of that phone booth, and start dialing. Talk to that therapist. Let every day be “when life is beautiful.”

And if Petula Clark wants to come along for the ride, well, she can afford the three-way calling option.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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