Assessing for
Psychogenic
Pain
[ Assessing for Psychogenic Pain ]
1.
Rule out of pathological
process (autoimmune
disease, etc.)
http://www.tmswiki.org/ppd/Find_a_TMS_Doctor_or_Therapist
[ Assessing for Psychogenic Pain ]
2.
Trauma or stressful
event
preceding pain?
[ Assessing for Psychogenic Pain ]
3.
Pain in multiple
places in body?
[ Assessing for Psychogenic Pain ]
4.
Inconsistency of
symptoms?
[ Assessing for Psychogenic Pain ]
5.
History of Anxiety
or Depression?
[ Assessing for Psychogenic Pain ]
6.
6.
Common Personality Traits
▣Perfectionistic
▣Putting others’ needs ahead of own needs
▣Self-critical
▣Hypervigilance
[ Assessing for Psychogenic Pain ]
7.
There can be physical
trauma preceding
symptoms, which can
be mild or severe
Accepting the
Diagnosis:
Importance,
Barriers,
Troubleshooting
Importance of Acceptance
Assuming your pain is psychogenic, one of the most important
components of your recovery is accepting the symptoms are
psychologically caused, as opposed to structurally or physically.
Barriers to Accepting Diagnosis
▣
“Does this mean my pain isn’t real?”
▣
“Does this mean I brought it upon myself?”
▣
Feeling of “weakness” or “shame” associated with having a mind-body
disorder.
▣
Associative Learning
▣
Evolutionary hard-wiring
Derbyshire, et. al. Neuroimage. 2004,23:392-401. 1=thalamus, 2=ACC, 3=pACC,4=cerebellum, 5=Sensory cortex,
6=S2, insula. T scores of ACC—PI pain=6.3; HI pain=4.3, Imagined pain=0.0
Associative Learning
Process by which an element is learned through
association with a separate, pre-occurring element.
▣ Walking/sitting
▣ Typing
▣ Running
back pain
wrist pain
leg pain
Associative Learning
One of the primary goals is to break the
conditioned response.
This process can be particularly difficult because
the conditioned response has likely been
reinforced thousands of times.
Breaking the
Pain Cycle
The
Pain
Cycle
Reframing the way
you think about the
pain can have a
direct impact of the
frequency and
severity of the
symptoms.
Breaking the Pain Cycle
Often people with psychogenic pain are reinforcing their symptoms without
realizing it.
Behavior = pain
Reinforcer = fear/preoccupation with pain
Because (in most cases, at least) the purpose of psychogenic pain is to
promote fear (more specifically warn one of a perceived threat), than fear
of/preoccupation with the pain serves to reinforce the symptoms.
Fear = fuel for the pain.
FEAR
Breaking the Pain Cycle
“Will this pain ever go away?”
“Wait- is it better or worse
than it was yesterday?”
“I’m not in pain right now,
when’s it going to come?”
Breaking the Pain Cycle
Neutralizing the fear of the pain decreases the power that the symptoms
have over you.
By no longer buying into these thoughts and fears, the pain loses its
reinforcement. And when a behavior is no longer getting reinforced, the
behavior loses its purpose.
Breaking the Pain Cycle
Extinction burst- When reinforcement is
cut off, behavior temporarily gets worse
before extinguishing.
Often when you take away the pain’s
reinforcement (fear, attention, etc.) the
pain gets worse before it goes away.
Original Goal
I want to get rid
of the pain.
Original Goal
I want to get rid
of the pain.
New Goal
Outcome
Independence
New Goal
Outcome independence one’s definition of success is
independent of a specific outcome.
Shifting to an attitude of outcome
independence is a great technique to
help overcome one’s preoccupation
with the pain.
Remember
The goal is not to prevent the pain
from coming on but to change the
way you respond when it does.