Biopsychosocial factors related to chronic pain are discussed as a necessary foundation for understanding and helping clients who are in pain. Familiar evidence-based counseling approaches that have proven useful for working with clients who are in pain are reviewed to identify how practitioners can use their counseling skills to help these clients. Approaches reviewed are assessment considerations, use of psychotropic medications, cognitive-behavioral strategies, hypnosis and imagery techniques, family considerations, and positive psychology.
Estimates of adults in the United States who suffer from some form of chronic pain vary from 10% to over 50% (Gatchel, Peng, Peters, Fuchs, & Turk, 2007). Primary medical providers report that pain-related office visits are second only to upper respiratory problems in the frequency of patient symptoms; back pain is the problem reported most often (Andersson, 1999; Hart, Deyo, & Cherkin, 1995). Most mental health counselors are not likely to encounter clients with issues related to pain at the inception of an acute pain-related episode. Instead, they are more likely to encounter clients for whom chronic pain has become either a primary or secondary presenting problem. Psychological and social factors that have been linked to the severity and level of disability associated with chronic pain include depression, anxiety, personality disorder, cognitive beliefs, substance use, childhood sexual abuse, and family dynamics (Lewandowski, Morris, Draucker, & Risko, 2007; Thorn, 2004; Turk & Monarch, 2002).
Clients in pain often wish to understand what is happening physically as well as receive support in dealing with their pain (Butler & Mosley, 2003; Otis, 2007; Thorn, 2004). To help clients understand the physical aspects of pain, mental health counselors need to understand the biology of pain as well as knowing appropriate counseling strategies that can be used with clients experiencing chronic pain (Gatchel, 2005; Gatchel et al., 2007). There is abundant research to support the effectiveness of psychological intervention for chronic pain, especially the application of cognitive-behavioral techniques (Turk & Gatchel, 2002). Although counseling interventions related to pain will depend on an assessment of the client, most counselors are familiar with therapeutic techniques to help clients with chronic pain. The goals of treatment are generally to give support, to assist in problem-solving, and to help reduce perceived pain, pain-related distress, and the disability associated with pain (Otis; Thorn).
BIOLOGICAL UNDERSTANDING OF PAIN AND CHRONIC PAIN
In a sense, all pain is neurogenic pain because the nervous system is the primary system that registers, regulates, assesses, and can feed the experience of pain (Butler & Mosley, 2003). Pain mechanisms can be divided into systems related to input, processing, and output (Butler, 2000). The primary systems of input are nociceptive pain and peripheral neurological pain. Pain etiology related to processing includes central nervous system plasticity changes and cognitive influences. Output systems that contribute to the pain experience include the sympathetic nervous system and the immune and endocrine systems (Butler).
Nociceptive pain is the physiological alarm system that alerts the brain, mildly or violently, that physical tissue damage is immanent or occurring. Nociceptive-generated pain refers to the pain processes that we experience when we puncture our skin, pull a muscle, or experience some other tissue damage. Nociceptors are distributed throughout the body, including the skin, muscles, joints, and organs. Once a critical threshold or thresholds of the activating mechanisms of nociceptors is surpassed, a pain signal is sent through the central nervous system and the sensation of pain is felt (Cummins, Sheets, & Waxman, 2007; Hainline, 2007). …