Why YOU are needed as a therapist for chronic pain patients.
The new zorgstandaard chronische pijn (published March 28, 2017) starts with some shocking facts: Chronic pain is a common health problem. A large European study shows that one in five adult Europeans suffers from chronic pain. In 34% the pain is even very severe, they score an 8 or higher on a 10-point scale (1 meaning no pain and 10 the worst pain imaginable, Breivik 2006).
Chronic pain causes a high consumption of care and a great loss of work capacity. The total direct and indirect costs for the Netherlands are estimated at €20 billion per year (Boonen 2005) and are many times higher than the costs for diabetes, heart disease and cancer (Gaskin 2012).
Various international studies show that the treatment of chronic pain is considered insufficient by 34-79% of patients (Breivik 2006, Smalbrugge 2007, Van Herk 2006). Also in a recent Dutch inventory of patients with chronic pain, the quality of the pain relief is perceived as moderate (Voerman 2015).
These figures: 1 in 5 adults suffer from chronic pain dating back to 2016. Since the start of the corona crisis in February 2020, our healthcare system has been under increased pressure. Waiting lists for non-acute care have more than doubled. Unfortunately, chronic pain is also listed as non-acute care. Waiting lists of 2 to 6 months in 2016 were unbearably long for many chronic pain patients (CPP). There is therefore a great need for other solutions.
Therapeutic lifestyle changes
In 2011 Roger Walsh published an article in the journal “American Psychologist” in which he states that in many chronic conditions, therapeutic lifestyle changes provide a measurably greater health benefit than many (expensive) regular medical treatments with drugs or psychotherapy.
Therapeutic lifestyle changes give patients control over their own health and thus increase self-confidence. Therapeutic lifestyle changes are cheaper than many medicines and medical care and therefore more accessible to a large group of people. Therapeutic lifestyle changes improve health, self-confidence and quality of life. These lifestyle changes such as meditation, relaxation, recreation and activities in nature are fun to do and therefore become healthy automatic habits. Good healthy habits also have a positive effect on people in the patient's environment.
Chronic pain in the brain
Many books and articles show changes in the brain in people who experience pain for a long time (more than 3 months).
All pain is made in the brain. Whether the pain arises or is maintained by the altered brain chemistry or whether the brain behaves differently due to the persistent pain is not clear. It is clear that the immune system is constantly on edge (and is often overworked), that the nervous system is chronically in survival mode, that the hormone system produces many stress hormones and the production of relaxing hormones is inhibited. That the limbic system constantly notices all stimuli and considers it life-threatening and negatively magnifies emotions out of pure protection. That the areas in the brain where pain is experienced grow and remain active in the brain.
Now it turns out that you can quite easily reprogram the brain using neurofeedback. This means that the brain waves are measured during training using an EEG. When the desired state of being is visible on the EEG, you will receive positive feedback.
Research is currently being conducted using neurofeedback through the tongue to resolve balance disorders.
Elite athletes use a program in which their brain waves disrupt music (which they listen to) when they are not in the right state of relaxation. In this way top athletes can learn to relax under great pressure. In the right relaxed state of being, the music sounds harmonious. When they are stressed, the music produces noise. This coupling of the brain (EEG) with the right behavior works very well, but is also often expensive.
Fortunately, you can also train the brain without expensive devices providing neurological feedback. In this case, you use physical behavior as feedback for the right state of being. To do this, we map out the undesired behavior (painful behavior) and determine the desired behavior, often behavior that allows the client to relax.
In my own experience as a chronic pain patient, I have tried all kinds of therapies, including medical treatments, nutritional supplements, and medications to help ease my pain. Ultimately, it turns out that only a lifestyle change and brain re-education is what works for me.
Roger Walsh's article shows that this is not only true in my case, but that therapeutic lifestyle changes work for many people with chronic conditions.
However, therapeutic lifestyle changes are not the same as positive thinking. While yoga and meditation can work very well for some people, it doesn't mean it's always the solution for everyone.
Therapeutic lifestyle changes mean that we as therapists have to study the client very carefully and map his or her entire life. It is not just about the physical pain that the client experiences or the emotional stress that he is suffering from.
This concerns all 6 axes of health: physical well-being, mental well-being, meaning, quality of life, social participation and daily functioning.
In all these areas, together with the client, we can determine which habits and behaviors maintain, reward or reinforce the pain. We can then determine for each area of health which of these habits can be changed and which behavior is desirable in its place. Then we will train to learn this new behavior.
As James Clear explains in his blog, new-habit takes an average of two months to learn and automate a new habit. In fact, we are going to create a new circuit in the brain, whereby new connections are formed. The training confirms and strengthens these new connections. However, the old negative habits that keep pain instantaneous don't just disappear. These will also continue to exist and will certainly appear again and again as an automatism in the beginning. Only by consciously choosing the new habit over and over again can the new habit gain the upper hand over the old unwanted pain system.
Because chronic pain patients are by definition not aware of their pain behavior (B. Van Cranenburgh), they need someone else to map this pain behavior with them.
Most therapists can do that very well.
Most therapists are trained to look at the client as a whole, not just the body, but also the social environment, the work. Most therapists are very capable of discovering together with the client which parts of the behavior can be changed and how. Most therapists are excellent coaches who can easily translate the end goal into achievable and measurable steps and guide and guide the client step by step.
As waiting lists for medical pain treatments have increased over the past two years, the amount of people experiencing chronic pain and feelings of depression has increased, many therapists are needed to help these people with therapeutic lifestyle changes.