Pain, and chronic pain in particular, causes stress, which may in turn lead to persistent phases of tension and overstimulation. This situation can lead to a lowering of the pain threshold, further intensifying pain and resulting in increased use of painkillers. This makes psychological care in cases of chronic pain a useful therapeutic instrument to help a patient manage the pain caused by his or her condition. The main thrust of this adjuvant therapy is to help the patient learn to deal with chronic pain by putting it in perspective, gaining some mental distance, and thus individually recovering some of the lost quality of life. Here are the most important psychological methods used in the treatment of chronic pain:
• Relaxation techniques
The most important techniques are autogenic training and Jacobson progressive muscle relaxation, both methods that can be learned under supervision, then practiced independently by patients.
The autogenic training concept was developed in 1932 by the physician I. H. Schultz. The basis of this technique is ”concentrated self-relaxation,” in which autosuggestion is used to achieve a change in psychovegetative functions. At the basic level of autogenic training, special perception exercises are used to achieve complete focus on one’s own body. The types of exercises:
- Warmth exercises involving the suggestive impression of warmth in the parts of the body
- Weight exercises involving the suggestive impression of heavy weight of parts of the body
- Attempts to influence respiratory and cardiac rates with specially designed exercises
After several weeks of training, physical reactions can be influenced so as to achieve a beneficial level of relaxation in stressful situations. At a more advanced level of autogenic training, the trainee selects images and situations to confront and consciously experiences. These exercises go beyond the achievement of a relaxed state and intensify one’s self-awareness and self-perception, creating a useful basis for problem-solving.
- Jacobson progressive muscle relaxation
During his physiological studies, the physician Jacobson (1885-1976) observed that a tensing of muscles often resulted in mental tension, disquiet and even a state of anxiety. Based on these insights, he developed a method of tension release. The objective of intense training in the Jacobson relaxation technique is to enable the patient to initially experience muscle groups intensively by briefly tensing them and holding the tension, then over the course of training to relax single and multiple muscle groups simultaneously, and to learn how to breathe regularly and slowly. The progressive element in this method is the ability, learned in regular training sessions, to very quickly reach a state of relaxation. Jacobson progressive muscle relaxation is easier to learn than autogenic training because the exercises can be done exactly as instructed by the therapist (e.g. in groups or from tapes). The objective is to learn how to achieve a state of physical relaxation that can reduce
tension, pain, and mental agitation on a day-to-day basis.
Among other indications, biofeedback is also used within the framework of behavioral therapy for pain. Most body processes take place outside the sphere of human awareness and cannot be consciously influenced. Classic examples include blood pressure and tensing of muscles, which are regulated by a number of independent influences without any conscious participation on our part. In the biofeedback method, small meters that generate an optical or acoustic signal are used to make us aware of (i.e. give us feedback on) current physical states (e.g. blood pressure level, tensing of muscles or skin). By experiencing these physical states, in the first phase of the biofeedback method the patient learns to become consciously aware of the various tension and relaxation states, and can memorize them. In the second phase, the patient learns to filter out and consciously generate the body signals that are beneficial, e.g. ”relaxed muscles,” or ”normal blood pressure” from among the many
different signals we receive from the body. After intensive training to increase awareness of the many different favorable and unfavorable physical sensations and states, initially supported by the appropriate biofeedback device, this method enables the subject to deliberately reproduce positive and favorable physical states using his learned perception of the body’s states. This method is based on the principle of operative conditioning, in which bodily processes are consciously perceived, registered as favorable or unfavorable and, in the final step, influenced and controlled at will.
The term hypnosis is derived from the Greek word hypnos, sleep, and can be defined as a deeply relaxed, sleep-like state that can be brought on by a therapist. Under hypnosis, the patient is completely relaxed, but retains control and cannot be manipulated by the hypnotherapist. The therapist helps the patient enter a state of mental and physical relaxation, in which immediate reality recedes into the background, and it becomes possible to raise the receptiveness of the subconscious for suggestions. In a hypnotic state, attempts are made to ”reprogram” a patient’s negative experiences or characteristics into positive characteristics or habits by means of suggestion. Medical hypnosis is used as a supportive measure in pain therapy, in addiction therapy and in the treatment of anxiety states, in addition to other areas.