Magazine article Psychotherapy Networker

Case Study, Reversing Chronic Paink: Ten Steps to Reduce Suffering

Magazine article Psychotherapy Networker

Case Study, Reversing Chronic Paink: Ten Steps to Reduce Suffering

Article excerpt

Case Study

Reversing Chronic Pain Ten steps to reduce suffering By Maggie Phillips

Chronic pain often has a clear physiological cause, arising out of an accident, an injury, an illness, or a surgery. But these days, more and more people are being referred to therapists with pain conditions that persist for months and years beyond the time when damaged cells, muscles, and tissues show every appearance of having healed and medical practitioners have pronounced that the initial accident, injury, or illness has been "cured." At this point, when traditional medicine seems to have done everything possible, people come to our offices hoping to find another way to understand why they're still in pain and--more important--what to do about it. Amy, a successful commercial artist in her late thirties, was such a client.

In our first session, she looked at me warily over the rims of her reading glasses as she clutched a thick folder in her lap. She was eager to tell me her story. "I've had five surgeries now for endometriosis," she began. "The first one was in 1990. I was having terrible, shooting, pelvic pain during my periods. They found a cyst on my ovary, and I had laser surgery to remove the cyst and some of the endometrial tissue. I felt immediate relief. But then slowy the symptoms came back again. In the next two years, I had more pain and two more surgeries, which helped temporarily. And then several years later, I started having bladder symptoms and two more surgeries, including a full hysterectomy.

"I'm worried about depression, yet the antidepressant I'm on has caused weight gain. I've been on medical disability from my job for the last six months, and though I'm practicing yoga, meditation, and walking one and a half miles per day, I feel no better and no closer to coming off disability. Do you think you can help me?"

When I see pain patients for consultation, it's all too common to hear this type of litany, in which the person describes becoming worse and worse, in part because of the interventions intended to repair the problem. At this point in the interview with Amy, I asked my standard questions.

Was there family history of this problem? "Yes," Amy told me. "Both my mother and sister have had endometriosis that's traveled a similar route. But they're out of pain now."

Was there other family history relevant to her pain? "I've been anxious all my life," she replied. "My father was alcoholic and physically abusive, and my mother busied herself with four younger children. I'd lie awake at night and listen to them argue, worried that things would really fall apart--that the family wouldn't survive."

We covered other topics, too. What was her relationship history? Her first marriage had ended in divorce, she said, when her daughter, Suzanna, now 23, had been 2 years old. She'd been married to her current husband, Jim, for 20 years, and it appeared to be a good marriage for them both. However, she was sad that there'd been no sexual intimacy for a long time, except when she'd taken heavy pain medication--which had led to an unsatisfying experience for both of them.

As empty nesters for the last several years since Suzanna had left for college, Amy and Jim had both worked 12-hour days in demanding jobs. Her increase in pain in the last two years had coincided with her boss'e retirement and her decision to take on the work of accounts manager while she continued to do "hands-on" commercial art projects.

"What helps?" I asked. She said she got relief from heat applications, Neurontin and Vicodin as pain medications, Paxil for depression, and Ambien and melatonin for sleep. Being in nature was healing for her, she added. She had several satisfying close friendships and enjoyed bicycling, needlework, reading, and going to the movies.

"What are you most scared about?" I asked next. Her eyes filled with tears as she whispered, "I'm scared I'll never get out of this hell of pain--that I'll only get worse with time, because that's what's happened so far. …

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