Article: 100 Million Americans Have Chronic Pain. Very Few Use One of the Best Tools to Treat it. [Vox]

“After weaning himself off the opioid Vicodin and feeling like he had exhausted every medical option, Golson turned to a book that described how pain could be purely psychological in origin. That ultimately took a pain psychologist, a therapist who specializes in pain — not a physician — to treat the true source: his fearful thoughts. Realizing that psychological therapy could help “was one of the most profoundly surprising experiences of my life,” Golson says. No doctor he ever saw “even hinted my pain might be psychogenic,” meaning pain that’s psychological in origin.

“Golson was lucky; few chronic pain patients ever get the chance to understand the psychological dimensions of their pain or try psychological therapies.

“There are 100 million Americans who suffer from chronic pain, and an unknown number of them are like Golson, with back pain, neck pain, fibromyalgia symptoms, or other forms of pain that have no diagnosed physical cause.

“It’s not that their pain is “in their heads.” The truth is much more nuanced: All pain can have both physical and psychological components. But the psychological component is often dismissed or never acknowledged.

“Big pharma’s aggressive marketing of pills and the minimal training doctors get in pain medicine mean that for too long, the go-to treatment for many forms of chronic pain has been opioids. Yet opioids have proven to be not only largely ineffective for treating most chronic pain but also highly addictive and risky.

“Cognitive behavioral therapy, meanwhile, shows meaningful benefits on chronic pain — both for psychogenic pain, and for pain with a physical cause — according to systematic reviews of the research. There’s also promising research around mindfulness-based stress reduction and therapies inspired by it.

“Yet pain psychologists are hard to find and hard to pay for, and most patients don’t even know they exist. “At the moment, [these therapies] tend to be seen as a route of no hope for the hopeless, for people who have gone through everything else,” says Amanda Williams, a psychological researcher who conducted one of the reviews of studies on the effectiveness of psychological therapy for pain.

“The question, then, is how we shift our understanding of pain so that psychology is the opposite of a last resort.”

Read Brian Resnick’s full article on Vox: 100 Million Americans Have Chronic Pain. Very Few Use One of the Best Tools to Treat it.

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Article: Physiotherapy Works Better When You Believe it Will Help You [The Conversation]

“What surprised us was that patients who had said they expected to “completely recover” as a result of physiotherapy did even better than patients who expected to “much improve”.

“The most important predictor of outcome was the person’s pain and disability at the first appointment. Higher levels of pain and disability were associated with higher levels six months later. And lower baseline levels were associated lower levels six months later. But this relationship often changed for people who had high “pain self-efficacy”, that is, confidence in the ability to carry on doing most things, despite having shoulder pain.

“Another surprise finding was that people with high baseline pain and disability, but with high levels of pain self-efficacy did as well as, and sometimes better than, people with low baseline pain and disability and low pain self-efficacy.

“This is the first study to investigate patient expectations of the outcome of physiotherapy for shoulder pain. Earlier research shows that high patient expectation of recovery predicts a better outcome following physiotherapy for back pain and neck pain, and a better outcome following orthopaedic surgery.

“On a similar note, this is the first study to show that higher pain self-efficacy predicts a better outcome in non-surgically managed shoulder pain. Previous research has shown that self-efficacy predicts a better outcome for a range of other health conditions. Also, people with higher self-efficacy are more likely to do the home-exercise programme  suggested by their physiotherapist.”

Read Rachel Chester’s full article at The Conversation: Physiotherapy Works Better When You Believe it Will Help You

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