Mental Health : Chronic Pain – And Where They Intersect
Dr. Geralyn Datz is a leading national mental health expert who has contributed to the National Pain Report. She is a chronic pain advocate. Recently, we discussed how her comments on Twitter about cognitive behavioral therapy can benefit the chronic pain community. Here are her comments:
National Pain Report: “We saw your tweet about Cognitive Behavioral Therapy for pain relief – you seem to indicate that workers comp and other insurers are viewing it not only more positively but may also cover it? Would you like to expand?”
Dr. Datz: “Sure. Psychotherapy as a whole is technically a covered service under workers compensation, and has been for many years. However, the challenge has been that acknowledging the mental health side of medical problems is something that Workers Comp has traditionally been loath to do. There are many reasons for this, but two of the most prominent have to do with the idea that the mind and body are separate, and that psychological suffering from pain, like depression or anxiety as a result of pain, is not in the realm of a “covered treatment”. Therefore, these services were often denied. The other challenge has been more legal, in that if a psychological disorder is acknowledged in an injured worker, this opens up liability for the insurer. Thankfully, these trends are really changing and the treatment of the whole person is now becoming an aspiration of many insurers, as well as recognizing that medical problems like chronic pain take a tremendous emotional toll on a person and require specialized treatment. There are more programs and providers now that are specifically focused on injured worker recovery using cognitive behavioral therapy, and insurers that support them.”
National Pain Report: “Explain what CBT is – how it works?”
Dr. Datz: “Cognitive behavioral therapy (CBT) is a specialized form of psychotherapy, talk therapy, that has a very strong evidence base. Basically, it has been shown to outperform many other types of therapy, and reduce symptoms of distress in people with chronic pain. CBT has worked more effectively than opioids in some patients. In short, it is viewed as a treatment that works. Cognitive behavioral therapy involves a working with a person with chronic pain and teaching them how their thoughts, feelings, and pain-related actions, can work for or against the person with pain. Chronic pain, while felt in the body, is experienced in the brain. Over time chronic pain actually rewires the brain in an unhelpful way, and ends up reinforcing itself over and over, which in turn causes the patient to focus on it more, worry about it more, dread it more, change their behaviors in response to it more. This becomes a vicious cycle that causes a lot of physical and emotional suffering. In CBT a pain patient is taught about the physiology of the pain response, how pain is represented in the brain, and how things like stress, anger, sleep disturbance, and anxiety over pain, all make pain worse. The person is then taught techniques for self-calming, tension reduction, and mental techniques which change thinking patterns, and this all helps to turn down the central nervous systems aggressive response to pain. CBT is considered very effective because research has shown that people who undergo CBT experience considerable relief, and actually have measurable changes in their brain in response to the treatment. Essentially CBT teaches people how to maximize the healing potential of their own brain.
NATIONAL PAIN REPORT: “For folks who can’t pay for it or their healthcare insurer won’t cover it—are there things they can by themselves?”
Dr. Datz: “Of course! There is always hope! I will say that if an insurance plan covers mental health, then they cover CBT. The main issue would be finding a provider who does CBT for chronic pain. That said, there are many helpful self-help resources like Master Your Pain by Jill Fancher PhD (@masteringpain), Less Pain, Fewer Pills by Beth Darnall PhD (@bethdarnall) both of which use these concepts. There is also an excellent self-help book for people with spine pain that is inoperable called Back In Control by Dr David Hanscom (@DrDavidHanscom), which discusses psychologically informed techniques and delves into the neuroscience of pain as well. I encourage anyone with pain to take advantage of these resources and seek as much help as they can.”
Dr. Datz was the leader of the Southern Pain Society…one of the few mental health leaders to be so honored. Here are some of her prior contributions to the National Pain Report.
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