Psychotherapy

Overview

Chronic pain is a complex problem. The subjective experience of pain depends on a variety of factors. Most patients who suffer from chronic pain quickly realize that the experience of pain may change quite dramatically depending on one’s state of mind. For example, chronic pain may worsen when the patient is stressed-out, sleep-deprived, or upset. In contrast, one’s pain may be quite bearable at times when the patient has a sense of well-being.

Other, more insidious psychological factors, sometimes unrecognized by the patient, may also amplify the intensity of pain. Untreated depression, unresolved conflicts, interpersonal issues with family or friends, disordered coping mechanisms, etc. may variably contribute to a patient’s pain experience. That is not to say that the pain originates from a psychological source. It typically doesn’t. Most chronic pain originates from a physical cause (nerve injury, tissue damage, scar tissue, etc.). Instead, psychological issues make whatever pain is present more difficult to treat. In fact, many forms of chronic pain cannot be completely treated, no matter how well the surgery or other treatments go, without psychological support.

Thus, it is important for most patients with chronic pelvic pain to undergo an evaluation by a pain psychologist. The purpose of this evaluation is to reveal whether any psychological issues are present. If they are, then they may be treated appropriately.

Some patients are initially resistant to seeing a pain psychologist, and wonder why they are being referred to one for an evaluation. Remember, patients and their physicians may be totally oblivious to some of the more subtle psychological amplifiers of chronic pain. In these cases, it may require a specialist in the psychology of chronic pain to reveal them.

References

Savidge CJ, Slade P. Psychological aspects of chronic pelvic pain. J Psychosom Res 1997;42:433-44.

Walling MK, Reiter RC, O’Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994;84:193-9.

Reiter RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol 1998;41:422-35.