Monday, June 10, 2013

The Psychology of Chronic Pain—Healing the Mind and Body

For Mental Health Month (May), we sat down with Angela Fletcher, Psy.D., the Director of the Behavioral Pain Medicine Program of our Pain Medicine Care Complex to talk psychology, and how it relates to pain.

Angela Fletcher, Psy. D.
The patients who come to the Behavioral Pain Medicine Program (BPM) have one symptom in common: chronic pain. “These patients have seen so many different doctors by the time they get to us, our job is to meet them where they are in their process and help them return to living a life to their fullest potential,” she says. “We can’t promise to completely take away their pain but we promise to teach them skills needed to cope and function with the pain on a daily basis.”

The BPM team characterizes the pain each patient experiences by the extent to which it impairs their normal, day-to-day activities.  Dr. Fletcher says, “Whether it is academic, social, family or emotional, our job is to pick apart the pieces and help improve their quality of life.”

An initial step for her team involves assessing their baseline functioning or ability in multiple areas of their life, and determining the extent to which anxiety and depression is interfering with the pain and maintaining the cycle. “Distract, measure and treat” is how the Pain Medicine Care Complex describes its overall treatment approach. The “distract” technique helps Dr. Fletcher’s team tease-out cause and effect between pain and anxiety and depression—at times, in just one or two appointments. She says, “We know biologically that distraction is proven in reducing pain, and once the patient can reintegrate and begin participating in normal activities, the pain decreases. Their functioning typically improves before the pain subsides.”

Dr. Fletcher teaches her patients “non-pharmacological strategies such as relaxation and mindfulness exercises to control the release of excessive cortisol levels. “There’s so much going on medically and psychosocially for youth experiencing chronic pain,” she notes. “We teach them coping techniques that reduce pain and help them feel more empowered to deal with the pain.”

In addition, the Behavioral Pain Medicine group has a very rotund, colorful helper: its one-of-a-kind POD bed. Designed by the man behind the furniture in the movie Men in Black III, the futuristic-looking POD bed was created to help patients to relax and decrease overall pain. The bed will eventually plug into a biofeedback machine that, while soothing the patient, will collect real-time data to measure and track patient improvement. Using soothing, colorful lighting and music synced to the patient’s breathing, a psychologist can help children focus on their inhale and exhale, while measuring their heart rate, muscle tension, skin conduction and body temperature. This information will then be used to help patients become attuned to how their body changes when they are in pain and under stress, compared to when they are calm and relaxed. 

Pain Medicine Care Complex, POD Bed
The Behavioral Pain Medicine team also provides education and training to parents to improve communication, help parents respond to a child’s pain in a consistent manner, and make sure parents encourage the youth to participate as much as possible in daily activities.

Dr. Fletcher’s team sees patients in multiple locations around the metro DC area. In addition, the clinic is in the beginning stages of collecting clinical data to track patient outcomes. This balance gives her a unique perspective that connects the world of clinical practice and research.

She says, “An important part of the psychological treatment of youth with chronic pain is to make the experience less stigmatizing, less intimidating. If you can give them an experience—like the POD bed or other forms of technology we use—that speaks to them in their language, they’re more receptive to returning and following through with treatment, which is essential to help them cope with their pain and get back to a normal, physically and socially active life.”


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  2. I do believe that in any condition with chronic pain if you get healed it with any way it is worth. There are many different ways for pain relief at various pain clinic orange county I have visited like chiropractic and others for back pain different.