I wet the bed every night.
While I'm still awake.
So you're not a "10" in every which way. But you're probably pretty spectacular in some way, and definitely good enough in most areas of life. If ever there were a time to stop beating yourself up for being human, it is now.
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Posted May 26, 2019
Only a small percentage of people living with chronic pain pursue help from a pain psychologist. On one hand, this is discouraging because pain psychology treatments have decades of scientific support for their benefits. Despite these proven benefits, however, mere thousands each year participate in pain psychology therapies among the millions struggling with chronic pain conditions.
On the other hand, it makes sense why few people think about a psychologist when considering treatment options for their chronic pain: most people believe that chronic pain is a medical condition, after all, and medical conditions require medical treatment. In the same way that it seems illogical for a person suffering from panic attacks to seek out a surgeon or a dentist, it seems equally illogical to most people with chronic pain to seek out a psychologist.
The reality is that no amount of scientific support will convince most people to try pain psychology therapies until a better explanation is provided to them for how these therapies can help. In this post, we review the five primary ways that pain psychologists help people with chronic pain.
1. Pain psychologists help people replace acute pain coping behaviors with chronic pain coping behaviors.
The most basic way that pain psychologists help is by showing people how to replace acute pain coping behaviors with chronic pain coping behaviors. All pain begins as acute pain; pain becomes chronic only when it persists past the expected length of time for healing to occur. We react instinctively to acute pain by avoiding painful activities, resting the painful area, seeking medical attention, and waiting for the pain symptoms to subside. These behaviors are both appropriate and effective… for acute pain. When the same pain becomes chronic, however, we need a new set of coping behaviors. Acute pain behaviors such as continued rest, activity avoidance and seeking medical care no longer help and often even worsen the disability associated with chronic pain. When you appreciate that managing chronic pain involves not only learning new chronic pain coping skills but also having to unlearn years of acute pain coping skills, then it makes more sense why a person might benefit from seeing a pain psychologist.
2. Pain psychologists promote the patient to the co-captain role in their pain management.
A second way that pain psychologists help chronic pain is by helping people adopt a leadership role in their treatment. During acute pain episodes, our role as the patient is typically to follow the instructions of our medical provider. The doctor is the expert and the clear leader in the treatment relationship. This model breaks down, however, with chronic pain. In the case of chronic pain, it is no longer effective for a person to simply follow the doctor’s advice and wait to get better. The patient with chronic pain must instead assume a more active role in their treatment, a role that may equal or even exceed the importance of their medical providers. For the successful treatment of chronic pain, the person must assume responsibility for making lifestyle changes, provide feedback to and make decisions with their physician, and become knowledgeable enough about their health to self-manage their symptoms effectively. A pain psychologist can help people in each of these latter roles.
3. Pain psychologists help people de-catastrophize their thinking about pain.
The third way that pain psychologists help chronic pain is by reducing what is known as catastrophic thinking. “Pain catastrophizing” refers to a tendency to interpret pain symptoms as a worst-case scenario. For example, pain catastrophizing might refer to the tendency for a person to interpret back pain symptoms as a sign that their back is broken or that a life-threatening tumor is causing their headaches. Pain catastrophizing activates our fight or flight response, produces fear and anxiety, and often leads to excessive treatment-seeking or an overreliance on pain medicines. If not addressed, pain catastrophizing can make the effects of chronic pain much worse than would otherwise be the case based only on a person’s medical status.
4. Pain psychologists help people spend more time with goals and values and less time with pain.
Pain psychologists also help people become less pain-focused and more value- and function-focused. Illustrated in the left image, chronic pain often takes over a person’s lifestyle, causing their days to become centered around pain, medicine-taking rituals, and medical visits. Over time, a person may become trapped in a life that has lost most sources of enjoyment, connection, and meaning. A central goal of pain psychology treatments is to help the patient resume living again in a way that is consistent with their goals and values, instead of waiting for their pain to resolve. Because chronic pain makes it difficult to be active, learning how to resume a more value- and function-oriented lifestyle is usually a process that takes time, practice, and a certain amount of trial and error.
5. Pain psychology helps decrease stress and mental health symptoms that worsen pain.
The fifth goal of a pain psychologist is to improve mental health and stress symptoms that are common to people living with chronic pain. How this part of treatment is applied varies depending on individual needs. One person, for example, may benefit from attention to pain-related depression or anxiety symptoms, whereas another person may benefit more from help to address marital or family relationships that often experience tremendous strain when someone is struggling with chronic pain.
I wet the bed every night.
While I'm still awake.
Here in the US most Americans do not have access to decent timely medical care, and this is leading to more chronic pain. This kind of article functions on two levels, one for people who are financially comfortable, who can afford to try a psychological approach to pain, that has already been diagnosed and appropriately treated by a physician, and the rest of the population. Psychologists have been misleading the public about the rates of pain in the US populations and the causes and treatments. By doing this they have created a measure of denial,, and a way to dismiss pain as unimportant or "All in ones head." Of course this is dependent on income, gender, race, and social status.
The facts are that this false narrative of psychology for pain, is usually instead of medical treatment or a clear diagnosis, even when there are serious underlying physical problems. None of the biased studies ever discusses the drop outs, or the people who had a serious misdiagnosed or diagnosed medical problem. They never explain how many of the people in their studies turned to suicide or ended up in the ER.
Since the mass media has been promoting the psychological approach for chronic pain, in older workers, injured workers and veterans, in an effort to protect profits and demeadn people with pain.
People with pain are committing suicide due to unrelenting ongoing chronic pain, and the stigma and hate directed at them, by psychologists who are pleasing the mass media.
Psychologists even made up the term "Catastrophizing" in order to further discredit people with pain, and Gas Light them. They had to come up with a false narrative to enrich themselves, and increase profits for the insurance companies, greedy employers, and protect physicians from liability.
This false narrative has ruined lives, led to more stigma of pain patients and led to suicides. Psychologists came up with a way to increase the denial and lack of empathy. They further isolated pain patients, turning so many into a life of living Hell. They gave physicians an excuse to deny treating people with pain, even when it meant they had an underlying condition like cancer.
People with chronic pain are committing suicide at increasing rates, especially older people, who have worked hard all of their lives, and have only pain to look forward to. They dismissed how stress, poverty and repetitive work, left people broken.
Psychologists turned the so called opioid epidemic into a marketing opportunity, and it has led to more deaths. Thanks to these clever content marketers, pain is no longer a symptom, it is a psychological disorder. Of course the people who have died or become permanently disabled due to their false narrative. Anyone looking at the biased research they claim is proof, will find that huge numbers drop out of these studies, because they increased their pain, frustration and stress. Psychologists tend to ignore the negative outcomes, even when they include death. We are really post science and post fact here in the US.
All we have to do is remember that the same psychologists who justified and explained away the torture of other human beings, applied this same kind of campaign of misinformation about people with pain.
Anonymous wrote:Here in the US most Americans do not have access to decent timely medical care, and this is leading to more chronic pain. This kind of article functions on two levels, one for people who are financially comfortable, who can afford to try a psychological approach to pain, that has already been diagnosed and appropriately treated by a physician, and the rest of the population. Psychologists have been misleading the public about the rates of pain in the US populations and the causes and treatments. By doing this they have created a measure of denial,, and a way to dismiss pain as unimportant or "All in ones head." Of course this is dependent on income, gender, race, and social status.
The facts are that this false narrative of psychology for pain, is usually instead of medical treatment or a clear diagnosis, even when there are serious underlying physical problems. None of the biased studies ever discusses the drop outs, or the people who had a serious misdiagnosed or diagnosed medical problem. They never explain how many of the people in their studies turned to suicide or ended up in the ER.
Since the mass media has been promoting the psychological approach for chronic pain, in older workers, injured workers and veterans, in an effort to protect profits and demeadn people with pain.
People with pain are committing suicide due to unrelenting ongoing chronic pain, and the stigma and hate directed at them, by psychologists who are pleasing the mass media.
Psychologists even made up the term "Catastrophizing" in order to further discredit people with pain, and Gas Light them. They had to come up with a false narrative to enrich themselves, and increase profits for the insurance companies, greedy employers, and protect physicians from liability.
This false narrative has ruined lives, led to more stigma of pain patients and led to suicides. Psychologists came up with a way to increase the denial and lack of empathy. They further isolated pain patients, turning so many into a life of living Hell. They gave physicians an excuse to deny treating people with pain, even when it meant they had an underlying condition like cancer.
People with chronic pain are committing suicide at increasing rates, especially older people, who have worked hard all of their lives, and have only pain to look forward to. They dismissed how stress, poverty and repetitive work, left people broken.
Psychologists turned the so called opioid epidemic into a marketing opportunity, and it has led to more deaths. Thanks to these clever content marketers, pain is no longer a symptom, it is a psychological disorder. Of course the people who have died or become permanently disabled due to their false narrative. Anyone looking at the biased research they claim is proof, will find that huge numbers drop out of these studies, because they increased their pain, frustration and stress. Psychologists tend to ignore the negative outcomes, even when they include death. We are really post science and post fact here in the US.All we have to do is remember that the same psychologists who justified and explained away the torture of other human beings, applied this same kind of campaign of misinformation about people with pain.
This article is really demeaning to people who live in chronic pain
Its easy for the psychologist to tell the person living with chronic pain to not catastrophize their pain. I have been living with pain for 18 years and have seen psychologists for pain management in the past and have never found it to be of lasting benefit. It's easy for the person sitting across from you to tell you to not catastrophize your pain when every sharp pain makes you wonder if this one will lead to more surgery or more damage. You also question whether it's all in your head when no one can tell you why it still hurts years later.
Pain psychologists are just one tool in the toolbox of pain management and they can be a great help when you're not having a flare up, but sometimes that isn't enough and that is where you need to have other tools at hand as well. Pain management needs to have a more holistic approach which includes GPs, pain specialists, psychologists, and physiotherapists working with the patient to find the treatment that works for them as an individual.
I'm immensely lucky to go to a pain management group run by someone who also lives with pain, and who understands that pain is subjective and the impact that it has on our lives is also unique to each of us, and how we manage it is also unique to each of us.
Millions of Americans are on the way to years of chronic pain. Many of the people working 2 or three jobs in the Gig Economy, and those stressed corporate workers, will end up with long tern chronic pain. The industries had to come up with a counter narrative. They need to keep all of the people who are not experiencing it yet, in denial.
Our broken healthcare system, had to come up with a way to dismiss all of those mistakes, while continuing to make obscene profits. They paid some researchers to come up with ways to perpetuate the lies and denial. There is no evidence that catastrophization exists, yet it is now a reason to deny medical care for serious pain conditions. Of course they only identify it in low value patients, surgical mistakes, and injured workers. They re-framed pain as a psychological issue, so they could limit access to virtually non existent health care.
Recently we found out that the FDA hid millions of device industry mistakes. There were a lot of deaths, but there were a lot of people left with intractable chronic pain. The industry needed a way to discredit those people and minimize any public response. They needed to override any human empathy and turn pain into a personal psychological issue, that psychologists believe people can be talked out
of. Virtually all of the research they claim validates this, is low quality, biased or amplifications of the "Hawthorne effect." The research the mass media is amplifying is deceptive, biased and misleading. These ghouls will not identify the problem, it could cost them money, and they could lose their precious online marketing jobs.
Catastrophization is the response to the Gas Lighting pain patients get regularly when they seek medical care. Psychologists know that they can trigger a response, by dead panning distressed and desperate people with long term intractable pain. It is really simple, they just act incredulous, when a person describes pain. They know that years of frustration, denial, lack of sleep and lost social activities have already taken their toll, so they will try to get an emotional response. Of course if the person describes their pain with a flat clinical affect, that is interpreted to mean they are lying too.
While this false narrative is going on, the medical lobbyists are claiming that imaging is not cost effective and can be dangerous. That means that people with pain, who have imaging and surgical scars to prove it, can now be disbelieved.
The various industries that are profiteering paid for the research, that they use to discredit people with pain. This is all part of a marketing, and propaganda campaign. They had to disparage people with pain, in order to continue to profit, both form denying them care, and selling treatments that don't work, but are very profitable. They needed to get the people headed for chronic pain to believe it can't happen to them. These psychologists needed to support the broken system, and discredit people with pain in order to get funding.
It is all lies propaganda and misinformation. In the meantime there are all kinds of self described advocacy groups, paid by big pharma, the device industry, or various health interests harvesting data online. This kind of deceptive marketing used to be illegal, now they have weaponized it.
Don’t forget about the many people who have chronic pain due to ongoing disease processes- autoimmune, inflammatory, neurological. They don’t fit into your one size fits all hypothesis.
The omission of those neurological and immune system disorders is by design. It shows why so much of this is misinformation. When they do the biased studies on "pain" they almost always use subjects with "low back pain" for a reason. The subjects have all been cleared by a doctor, so none of them have an underlying condition. Any time we see a headline or a sensationalized articles about pain, miracle cures or psychological cures, they are usually referring to medically cleared low back pain. They deliberately misreport that as if it applies to all of the other conditions. More than 90% of the time LBP clears up on it's own, so they attribute their psychological or new age cure to that fact. It is misleading and deceptive, but people want to believe in magic.
Almost every "cure' you read about in mass media is in early stage rat or mouse studies. these tell us nothing, and ver few ever translate to humans. There is even a Hashtag for it, inmice. Real scietists are fed up with the amount of psuedo scince and garbage promoted by sites like this, patient advocacy groups, and the mass media.
Psychologists are some of the worst offenders, because this is advertising for them. There are no laws or ethical considerations, anymore. The US used to have laws about advertising to protect patients, but the Neo Liberals did away with them.
Most psychologists have no medical background, so they do not understand that these disorders won't go away with Gas Lighting and good thoughts. They don't understand, or don't want to understand how studies or science works. They don't understand difference between Qualitative and Quantitative, and mixing the two is better for marketing their services. No study was ever done to see how these psychological interventions work in the real world either. If you look at any of the research, there are a lot of "drop outs" and in some cases these are suicides, or people whose pain increased due to participation.
These advertisements are on two levels. The first one the target audience, people with money and access to good medical care, in that case psychological interventions are probably helpful. On the other hand there are lot of people, especially people of color, women and low income people who do not have good healthcare, and psychology is meant to replace a medical diagnosis, and treatment. 90 percent of the time, it may help, but it is the other 10 percent, with real issues, and underlying conditions, it could kill. None of this is reflected in the research, since it is about marketing and propaganda anyway.
When you look at what they are doing it is really scary, they want the public to believe that pain can be talked away. I connect it back to the psychologists who endorsed torture. They really had to override human empathy, so no one would care about sick people. The constant barrage of misinformation about pain, even led to families turning on sick people. A few years back they deliberately conflated pain and addiction, it was good for business. They ran that false narrative long enough to get the uninformed to believe it.
The so called opioid epidemic has been really good for their business. They have been using it to market all kinds of misinformation.
Dr. Rutledge, As a psychiatrist and a chronic pain patient, I agree with you that the treatment you recommend can be extremely useful. It needs to be more highly recommended. I also think that too often all practioners (and all patients) get rushed into thinking about treatment before everybody has a firm handle on diagnosis. In the case of chronic pain management, the problem is that early childhood training combined with natural proclivity teaches us that pain is a signal that "something is wrong! Something needs to be fixed!" There is no clear point at which we know with certainty that medical intervention is no longer required, or is required at a vastly different level. I have interacted with physicians in all fields of medicine who have fallen far short in giving their patients the information they need to come to grips with the facts of their chronic pain situations, whatever those facts may be, from case to case. No patient can let go of the abiding sense that pain is an indication of impending danger until their physician gives them positive permission to think about their pain in a different light. In cases where pain, in fact, continues to be a signal of bodily destruction but must be coped with anyway, the discussion between physician and patient will be that much more complicated. But until that discussion is had, no chronic pain management program in the world has a chance of being effective. In the case of chronic pain management, I do not think the onus is on the patient to view the situation differently. I believe we practioners are not giving our patients a huge piece of the assessments, inclusive of the state of medical understanding of the neurological and other physiological contribution to their pain, that they must incorporate, in order to be able to understand how and why their treatment plans will be effective. Chronic pain is complicated. Our approach to it must respect the deep unease and confusion patients experience emotionally in addition to their physical discomfort.
I have been tracking how this topic has been covered in media, and how deceptive some of the research is that gets media attention.
Here in the US a lot of people do not have accesses to actual healthcare. The assumptions that people with pain are even getting diagnosed and need to learn to process is absurd. A lot more people work off, and suck it up and go back to work, than seek pain "treatment."
Psychologists and psychiatrists have give out dangerous advice, to increase profits for the medical and insurance industries. It is easy to see how this is negatively impacting the lives of people with chronic pain.
It is funny that no psychologists or psychiatrists looked at the marketing, lies and propaganda around this topic. Not one looked at the negative impact of the CDC guidelines, or the damage it did to people who actually have pain.
In other developed nations workers can take time off, when they are injured. Here in the US, many of the big box employees and blue collar workers don't. As the US population ages, more people will have pain conditions from years of repetitive work, long commutes and stress. the industries had to come up with a counter-narrative, create doubt and override human empathy.
Removing pain from the medical industry has been useful for marketers and deniers. Psychologists regularly conflate pain and addiction to get funding or attention for their "research." The media picks up the most outrageous misleading "studies" and misreports them.
At this time the nation claims we have an opioid epidemic, they used this false narrative to demean, undermine and stigmatize people with pain. The "researchers" with the most absurd and controversial findings got media attention. Denying that pain exists is good business. In a nation were a lot of people don't even have accesses to physicians, they needed an out. They needed to add to the denial.
Last week there was a protest at the CDC, their guidelines were of course misinterpreted and people with chronic pain were denied treatment. This included veterans, some with serious injuries, who due to the misinformation could no longer get pain medication. The entire response to all of this has been more misinformation, and lies.
Unfortunately the pain discussion got tangled up in the "War on Drugs." Gas lighting people with pain was the only response. No research was done on the negative impact. The industries profiting here would not pay for that kind of research.
Physicians don't work for the patients anymore, they work for the insurance companies and big health providers. We have clear evidence that is not improving health outcomes. Physicians that do treat pain can be arrested, they are under threat. The big health providers are profiting from all of the lies and misinformation. They advertised and sold expensive and dangerous procedures, implants, and injections, instead of pain medication. The FDA helped the industry by burying the adverse incidents, to protect corporate profits.
No Psychiatrists have bothered to study the negative impact on our health or our society, by deceptive marketing, misleading news articles, which are just content marketing.
The rising suicide rate herein the US, might be an indicator that something is wrong. Just look at some of the topics in this publication, misleading articles on "pain psychology" and dating tips, nothing truly informing.
Look at what they are doing at Stanford, and other academic institutions. Creating biased research to please their corporate funders, not to identify facts. They even turned the research into content marketing.
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