By Richard LeComte
Photos by Samantha Hernandez
Many persons suffering from chronic pain are left with more questions than answers. What’s wrong with me? Why won’t it stop? How awful will this get?
Often, people with chronic pain become depressed, anxious, isolated, shunted aside. Chronic-pain sufferers sometimes find that medical cures aren’t coming, and the disappointment can be devastating.
“These people have intervention after intervention, and their pain doesn’t go away,” says Dr. Beverly Thorn, a clinical psychologist and chair of UA’s psychology department.
Researchers are helping patients tap into the healing power of the mind to give hope to persons with pain. If these people can learn to think differently about their situation – to learn to navigate the mental pitfalls associated with a chronic illness — they may find their suffering abates. That’s the foundation upon which Thorn has built a series of successful clinical research programs helping patients manage chronic pain.
“Can we reverse the physical pathology?” Thorn asks. “No. But, can we learn how to manage pain? Yes. Think of chronic pain as a chronic illness, like diabetes is a chronic illness. You don’t expect it to go away, you expect to manage it. Doing so improves mood, gets people off the couch, and lowers the ‘stress thermostat,’ all of which reduce pain levels and help people regain lost function.”
Former firefighter Larry Burnette, for example, was injured in an explosion in his line of work when he was in his late 30s. The explosion broke his pelvis on the right side and damaged muscles and nerves. The pain persists, and although he says he’s tried to keep a positive attitude, he knows his life has changed, and he must plan for, and anticipate, pain.
“I thought that overnight I had gone from being 36 to being 60,” says Burnette, who is not involved in one of Thorn’s studies. “I know that I’m going to be in pain by the afternoon, so anything physical I have to get done before lunchtime.”
He returned to school and now works as a high school American history and economics teacher. He needs a custom driver’s seat for his car, and he misses some of the things he used to do.
“I was going through that big adjustment,” Burnette says. “I no longer do recreational things I used to – I was a kickboxer, but I gave that up.”
These problems are the kind Thorn addresses in her treatment and research. Cognitive-behavioral therapy – what Thorn calls “the gold standard of psycho-social treatment” – involves teaching participants to identify negative automatic thought patterns, recognize the powerful hold these thoughts have on their ability to cope, and learn skills to use their minds to their advantage.
The therapy assumes that pain is a multi-dimensional experience that can’t be reduced to a purely sensory phenomenon.
“The model, called the gate control theory of pain, states that the emotion and thought centers in our brain actually have the ability to control the amount of pain experienced,” Thorn says. “So, if you have a handle on the emotional and thought centers, you can actually reduce the incoming pain signals to your brain, thereby decreasing the amount of pain you experience.”
The UA College of Arts and Sciences researcher is exploring two approaches built upon these principles. In one recently completed project, Thorn received a grant from the National Institutes of Health to see if cognitive behavioral therapy, adapted for lower-literacy people, would be equally effective as previous studies with primarily high-income individuals with chronic pain.
The participants underwent pre- and post-testing to measure their pain levels and overall mood. Following the program, participants reported lower levels of pain and interference in daily activities, lower depression, fewer catastrophic thoughts about pain and increased quality of life. Participants described a process of change that involved letting go of the desperate need to find a “fix,” which freed them to re-engage in the meaningful activities of life. These findings are now in press in the scientific journals Pain and Journal of Pain.
In the second project, Thorn and doctoral student Melissa Day are investigating a technique incorporating mindfulness meditation into the CBT approach. Mindfulness-based approaches are helpful for a number of health problems, including chronic pain. This study, funded by the Marchionne and National Headache foundations, uses mindfulness-based cognitive therapy to treat locally referred patients with chronic headache.
“The mindfulness component teaches people to be aware of the immediate moment without judging or trying to run away from it. In this way, it cultivates acceptance of the current moment just as it is,” Day says. “The approach is another way to remove the extra cognitive and emotional baggage associated with the sensory input. The mindful-based approach is more experiential, and less didactic, than cognitive behavioral therapy . . .”
Thorn and her colleagues believe their research will lead to a better understanding of how pain works in the mind and to less suffering for people who experience chronic pain. To bolster their assertions, they cite evidence from studies using functional magnetic resonance imaging of the brain showing cognitive behavioral therapy techniques can “rewire” the brain to change the pain experience.
“These techniques involve the mind and the body and give appropriate consideration to the importance of both,” Thorn says. “The ultimate goal involves expanding the repertoire of available and effective tools in the pain management toolbox, and, ultimately, giving pain sufferers their lives back.”
The University of Alabama, the state’s oldest and largest public institution of higher education, is a student-centered research university that draws the best and brightest to an academic community committed to providing a premier undergraduate and graduate education. UA is dedicated to achieving excellence in scholarship, collaboration and intellectual engagement; providing public outreach and service to the state of Alabama and the nation; and nurturing a campus environment that fosters collegiality, respect and inclusivity.