Simple psychological pain therapy

Simple psychological pain therapy

Abstract:

Pain is an excruciating feeling that can lead to a crisis of psychological well-being in which doctors end up overdosing on medications that cause more damage to the body's systems and often cannot deal with phantom pain and the reduction of real pain. In this post we will examine the nature of pain with and without injury and its disabling effect on everyday functioning and life. We will explore the nature of pain and some simple techniques to treat and even eliminate chronic pain.

Introduction:

Neuropsychology studies the function and plasticity of the brain and particularly the central nervous system. The body's pain system itself is a fairly complex arrangement of gates and centers with nerves that are attuned to specific types of pain we may experience. There are different types of pain, for example:

skin

Direct stimulation to the skin (incision)

Somatic

From the musculoskeletal system (muscle congestion)

Visceral

From hollow organs (appendicitis)

Pain also comes from experiencing a feeling. We typically ask patients how much pain they feel on a scale of 1 to 10 - e.g. B. 1 would be no pain until 10, which would feel excruciating and almost unbearable. Words can also help patients describe their experiences, such as: B. dull, sharp, nagging and constant etc.

The brain itself interprets these feelings into a cognitive function of the experience, for example we judge the likely cause and damage to our body by thinking about the pain and where that pain comes from. A pain in the stomach could be interpreted as indigestion, and in the chest it could be interpreted as a heart problem. Neither need be true – our perception simply rationalizes our experience of pain. In a serious accident in which we are seriously injured, our brain would be overloaded with a fear response, so we activate a shock system to minimize the experience of real pain for the brain to a cognitively acceptable level of functioning. Otherwise our brain would be overwhelmed by the pain and would create the conditions for a stroke, for example. However, our central and peripheral nervous systems are designed to automatically minimize pain in the event of major physical damage. The spine contains many pain gates that are connected to our pain receptors in the skin. When damage occurs, the pain signal is sent to the spinal nerves to inform the brain that we are injured in some way. If the pain is too severe (shock situation), then when the first signals arrive in the brain, opiates are produced, which descend from the brain via the raphe nuclei and further into the dorsal columns of the spine. Here, serotonergic activity stimulates inhibitory interneurons that block pain. This is done to make the pain manageable now that we know we are hurting and can take action to remedy the situation. (1. Basbaum & Fields 1978). Also remember that vision is a strong indicator to the brain that we are in serious trouble and opiates may be produced even before the actual pain is physically perceived. We can also suffer damage that we are not initially aware of, but immediately feel pain when we see the injury.

Neuropathic pain:

Pain is felt here where there is no obvious damage to the physiological system. This can happen after an injury to the muscles (strained shoulder), which takes a long time to heal and return to normal functioning, but we still have severe pain in the area of ​​​​the injury. Often this type of pain begins in a careless moment, when we are reminded of the injury by touch or even someone mentions their own injury, we immediately feel the pain as if we were still injured. One theory of this type of pain is memory, which is activated by the habituation of our reflex actions to the original damage to the muscle. For example, we dislocate our shoulder, the pain is severe, we can't stop thinking about it - any movement causes painful spasms - so we stiffen, move carefully and avoid touching the area. Then we heal, but now that memory of pain is embedded in our cognitive memory. The habit of pain becomes real even when we think about it or are reminded of it. Our nervous system is trained to trigger a pain response in an area of ​​our body that is actually no longer damaged. (2. Myler 2015). Some research suggests that pathological changes in the nervous system are hardwired into memory. (3. Reichling & Levine 2009). Others believe that glial cells in the pain system remember independently of perception and produce hyperactivity of neural pain pathways. (4. Fields 2009) A good example of this phenomenon is the phantom limb - where the arm or leg has been surgically removed but continues to cause a pain response even though it no longer exists. Painkillers have little effect on neuropathic pain and actually damage other organs, although high doses are often prescribed by primary care physicians who don't know how to deal with a troubled patient with pain they can't manage. Having understood the brain's response to pain, we should also remember that pain is a function of the nervous system that tells us information about our well-being, and although we perceive pain negatively, it is a positive mechanism for our survival.

Pain management: Pharmacological

The most common nonsteroidal anti-inflammatory drug (NSAID) for pain is ibuprofen. This medication helps relax muscles and reduce swelling. It is also easy to buy directly from any pharmacy. The most common brands are Advil, Nuprin and Pamprin IB. The best pain relief is often provided by one of the oldest known medications - the simple Asprin. However, there is a long list of prescription-only medications, most of which have doubtful effectiveness due to high side effects and damage to the body's organs from long-term use.

Flurbiprofen (Ansaid)

Ketoprofen (Oruvail)

Oxaprozin (Daypro)

Diclofenac sodium (Voltaren, Voltaren-XR, Cataflam)

Etodolac (Lodin)

Indomethacin (Indocin, Indocin-SR)

Ketorolac (Toradol)

Sulindac (Clinoril)

Tolmetin (Tolectin)

Meclofenamate (Meclomen)

Mefenamic acid (Ponstel)

Nabumetone (Relafen)

Piroxicam (Felden)

The main side effect of this type of medicine is that it can cause bleeding and irritation in the stomach. This bleeding usually occurs after long-term use, but can also occur with short-term use. Long-term use can also affect the kidneys. In general, the analgesic effect does not increase with higher doses; Thus, 400 mg of Motrin has the same amount of pain relief as 800 mg of Motrin. At a higher dose, a person is more likely to suffer from a significant stomach problem. (5. John P. Cunha, DO, FACOEP 2015). The message here is clear: avoid medications when possible, especially for long-term use.

Pain therapy – psychological

One of the most discussed pain management techniques is hypnosis. However, the evidence shows that it is a popular method, but most of the time it fails and is ineffective. Even if you unconsciously ignore the pain, it doesn't last long and you keep going back for more sessions and of course spending a disproportionate amount of money. Today, most clinical psychologists use visualization rather than hypnosis. Visualization asks the patient to concentrate on a pleasant painting or photo and imagine that they are in the picture and part of a story - this distraction can be repeated internally after a little practice without the actual picture being present. You can just see it in your mind's eye and focus on continuing the story. Although there is evidence that hypnosis can reduce or even eliminate pain, this is only short-term and is therefore more useful for smaller operations where painkillers cannot be used, for example in allergy sufferers. (6. Graham Hill 1998)

Remember that the brain perceives pain through the cognitive assessment of the severity and extent of the damage observed. To change this perception, one must get the brain to focus away from the perceived area of ​​pain. An example here would be the Paradox Method (7 Myler 2014), if the pain is in the left shoulder, you should tap or rub the right shoulder, where no injury has ever occurred. The effect of this paradox is that pain lessons are taken on the right while the nerves on the left are stimulated. The brain shifts its focus to the stimulation area and only perceives a pleasant massage feeling. This has the effect of also teaching the habitual memory that was established when the shoulder was originally damaged. An everyday example of this is when we hit our knee against the edge of the coffee table - we naturally start to rub our knee, stimulating all the nerves around the sharp spot, which then immediately dulls the pain overall. This additional stimulation acts on the pain gates in the spine to pass more information to the brain about the injury, which is less severe than the original point of contact with the edge of the table. Another method is the relaxation technique before moving. (8. Myler 2013). If a movement causes pain in one area of ​​the body, take time to relax before the larger movement. This can be achieved by a simple countdown - from 10 to 0 - before moving. As you slowly count down – consciously relax your body – then move. This technique has been proven again in many clinical cases to retrain the body to accept less discomfort when moving, especially in phantom limb pain where the damage has long since healed.

Another paradoxical method is to cause the pain. Here, if your patient is suffering from a headache, you can ask the patient to try to get a headache - this is almost an impossible task - and so when the patient feels the headache, he actually tries to make it worse and fails. It sounds strange that creating a paradox works, but for many patients it has remarkable effects.

Other complementary methods

For physical pain, especially sports injuries and the spine, a physical therapy massage can be very effective in relaxing the sore muscles. In fact, physical therapy is mostly about pain relief, training muscles to function effectively again after an injury. Chiropractic methods are also effective where pain is caused by pinched nerves in the spine. Vertebral displacement can cause nerves from the spine to exit into the peripheral system to provide pain impulses to the brain that are unrelated to an actual injury. The chiropractor (or rehabilitation specialist) can readjust the spine through physical hand manipulation to restore the normal curvature and alignment of the spine, thereby freeing the pinched nerves and eliminating the pain. (9. B. Diskin 2014). Many patients who suffer from stress experience physical pain and therefore seek chiropractic or physical therapy to relieve tension in the neck and lower back. However, dealing with the stress yourself through psychotherapy may actually be more effective in the long run.

Summery:

Pain is a disabling experience that can cause a person to interfere with enjoyment of everyday life by becoming distracted and dysfunctional. To combat the different types of pain and their severity, a combination of methods of medical pain relief, complementary methods and highly effective psychological pain therapy is required.

References:

1. Basbaum & Fields 1978 – Biopsychologie 8. Aufl. Pearson-Publikationen S. 182
2. Myler 2015 – Fallstudien – Sky Clinic Shanghai
3. Reichling & Levine 2009 – Biopsychologie 8. Aufl. Pearson-Publikationen S. 183
4. Felder 2009 – Biopsychologie 8. Aufl. Pearson-Publikationen S. 183
5. John P. Cunha DO, FACOEP emedicinehealth.com/pain_medications/article_em.htm
6. Graham Hill 1998 – Fortgeschrittene Psychologie durch Diagramme Oxford University Press.
7. Myler 2014 – Fallstudien – Shanghai East International Medical Center Shanghai
8. Myler 2013 – Fallstudien – Healthway Medical Center Shanghai
9. B. Diskin 2014 – Krankenhausvorträge – St. Michaels Hospital Shanghai

Inspired by Stephen F. Myler