Hospital and Physician Update

January – February 2020

Guest column from Kenneth L. Salzman, Ph.D., licensed psychologist
What role can psychotherapy play in pain management?

Approximately 50 million American adults — 20.4% of the U.S. adult population — have chronic pain, according to the Centers for Disease Control and Prevention. That’s a staggering number.

Chronic pain is defined as pain on most days or every day for at least the past six months.

When pain persists for a period of months, rather than days, it poses a serious problem. It suggests that the pain the patient is experiencing wasn’t readily resolved by medical means. It also puts patients at risk of becoming addicted to opioids in an effort to mitigate their pain.

That’s where the behavioral specialist’s skill set comes into play. Among the tools in the behavioral specialist’s skill set are methods of training patients to quiet their minds, relax their bodies and shift their focus away from the perception of pain.

When people have pain they can’t get rid of, their first thought is to try to “clamp down” on it, “push it away,” or in some other active manner, “get rid” of the distress. Unfortunately, this typically results in exacerbating rather than reducing the pain.

Most people have experienced a minor pain, headache, minor injury, stomach ache or the like, which, when they got distracted, ceased to be part of their immediate consciousness. For the period of the distraction, they were not experiencing pain.

The distraction served as a shifting of consciousness away from the pain, essentially negating the importance of that signal. The pain was still there; it just wasn’t part of the perceptual space. There are psychotherapeutic techniques that can provide the patient with the ability to shift their own consciousness at will, mitigating or eliminating the pain perception.

Even severe pain is subject to levels of perceptual control. You might be familiar with patients who were in shock from a recent trauma and expressed no experience of pain. The mechanisms that produce that result are accessible through means other than shock and can be learned by the patient.

These are just a few of the options and methods available to the behavioral specialist that, along with ongoing monitoring of medication, pain levels and other factors, makes psychotherapy an important addition to any chronic pain treatment plan.

Kenneth L. Salzman is a licensed psychologist in independent private practice in Lansing. He currently serves on the Insurance Committee of the Michigan Psychological Association and has worked with Blue Cross and other health care plans to help facilitate the integration of behavioral services with medical systems.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.