Page 37 Guide to Pain Management in Low-Resource Settings

Psychological Factors in Chronic Pain 25

overall fi tness level, improvement in cardiovascular and professional requirements [behavior prevention]) and
pulmonary capacity, coordination and body percep- a change in the variables of the professional environ-
tion, and an improved capacity to handle stress. Th e mental (e.g., transfer within the workplace or retraining
psychotherapeutic interventions try to change adverse [conditional prevention]).
emotional eff ects (antidepressive therapy). Th e patient’s
behavior is based on rest and relaxation, along with Eff ectiveness of psychologically
changing cognitively represented attitudes or anxieties based therapies
with regard to activity and the ability to work.
Th e focus of this psychological (cognitive-be- Th e eff ectiveness of psychological pain therapy for
havioral) therapy is similar to that of the psychological chronic pain patients is suffi ciently documented. Several
methods described above. Th e therapy is highly somati- meta-analytical studies have shown that about two out
cally oriented, but the psychological eff ects of the train- of three chronic patients were able to return to work af-
ing are just as important as the changes achieved in ter having undergone cognitive-behavioral pain therapy.
terms of muscle strength, endurance, and coordination. Cognitive-behavioral therapy techniques, compared to
Intense physical activity is included in order to: exclusively medication-based therapy, are eff ective in
1) Decrease movement-related anxiety and func- terms of a reduction of the pain experience, an improve-
tional motor blockages. ment in the ability to cope with pain, a reduction of pain
2) Sever the learned connection between pain and behavior, and an increase in functionality; most eff ects
activity. can be maintained over time.
3) Provide the necessary training to cope with stress. Behavioral therapy is not just one homog-
4) Provide fun and enjoyment, which is usually ex- enous therapy, but consists of several intervention
perienced during the playful parts of therapy and can methods, each of which is geared toward a specifi c
lead to new emotional experiences. modifi cation goal. However, this multidimensional ad-
Insights gleaned from the theory of learning vantage is also a disadvantage, because it is often not
show that pain must lose its discriminating function quite clear what kind of content is needed. Th e eff ect
for patients to be able to manage their pain behavior. itself has been proven without a doubt, but it is much
Th erefore, the entire physical training cannot be geared less clear why and in which combination the interven-
toward the pain it causes, or be limited by it, but must tions are eff ective.
instead be geared toward personalized preset goals.
Goal plans strengthen the patient’s experience of man- Pearls of wisdom
ageability and self-effi cacy. Failures at the beginning of
therapy (e.g., if goals are not reached) could signifi cantly • Psychogenic processes play an important role in
reduce the patient’s motivation, initial goals should be the complex processing of pain information. Th e
very simple (weight, number of repetitions). Patients’ pain, therefore, aff ects not only the body, but the
beliefs about their illness, particularly with regard to human being as a whole. It becomes more se-
movement-related fears, must be given particular atten- vere if the patient does not know the causes or
tion during therapy. Th ese fears must be specifi cally re- the signifi cance of the pain, which, in turn, leads
corded and decreased in a gradual training process that to anxiety and increased pain levels.
mimics the behavior as closely as possible. • In terms of chronic disorders, various factors in
Physical training machinery can be used dur- their individual development have an additive ef-
ing the training (the patient feels safe due to the guid- fect. Th erefore, an explanatory model can help
ed, limited movements), but they constitute “artifi - determine the best therapeutic approach, which
cial” conditions and thus hinder the necessary transfer equally includes biological (somatic), psycho-
to daily life. Consequently, routine everyday activi- logical, and sociological components. Th is model
ties should be incorporated into the training as early focuses not on details that are no longer identifi -
as possible. Since there is a close connection between able, but on the interactive whole.
back pain and the workplace, the therapy must be en- • Th e patient himself is only a fi xed, actively func-
hanced by socio-therapeutic interventions (adjustment tioning component of the process, if he is willing
of the individual’s capabilities to his or her profi le of to actively participate in the necessary behavioral