Talking Away Pain

He walked more slowly than a very old man

With his confident stride, it is difficult to tell that Mr Yeap Yew Chai was once so wracked with pain he needed a wheelchair to move around.

Psychotherapy has since helped the 27-year-old walk normally again – by showing him the way to manage his pain.

The descent into excruciating pain for the financial firm trainee started six years ago, when he could not move after waking up: a sharp pain wracked his lower back. “I needed 30 minutes to get out of bed,” he recalled.

The pain did not go away and his mobility became limited during the day.

His family and girlfriend had to help him move about. A medical examination showed that he had a slipped disc. He went for rehabilitation and surgery, but the pain remained, even after 11/2 years.

“I walked more slowly than a very old person,” he said.

Worried that he had become an emotional and financial burden to his parents, he fell into a slight depression.

He checked himself into an intensive rehabilitation programme at the Ang Mo Kio-Thye Hua Kwan Hospital for a month.

The pain was so bad he needed a wheelchair.

When the rehabilitation stint ended, he was referred to the cognitive behavioural therapy pain management programme at Tan Tock Seng Hospital.

There, he was taught how to deal with his affliction step by step.

For example, he could not sit for 30 minutes without feeling pain. To combat this, he started by sitting for 15 minutes first.

Then, as he learnt to cope with the pain, he was able to progress to sitting for longer durations.

He also learnt how to reverse his negative thoughts.

Whenever he felt like a burden to his loved ones, he focused on how he could lessen their anxieties by working hard on therapy.

Today, he walks normally although the pain is still present.

The once-active sportsman, who has won basketball trophies, now accepts that the pain is here to stay.

When painkillers no longer work, psychotherapy can be the next step in treating chronic pain. GERALDINE LING reports.

It is not uncommon to reach for that pack of painkiller pills when in pain, like that from a headache.

However, popping over-the-counter pills may not be the panacea when seeking relief from chronic pain.

When medical intervention alone does not seem to work, one method – psychotherapy, also called talk therapy – has even medical personnel giving it the thumbs up.

Pain is chronic when it lasts more than three months. It may affect up to 20 per cent of the population.

Chronic pain can affect the back, neck and arthritic joint.

Sometimes, pain can also return to an old injury site – say a fracture or whiplash – even after the injury has healed physically, said Madam Jamilah Chemat, a nurse clinician at the spine and chronic pain clinic at Tan Tock Seng Hospital (TTSH).

While this pain is often dismissed by some as being imaginary, Madam Jamilah said it can be very real.

Elaborating on this, Ms Yang Su-Yin, a senior psychologist at the department of psychology services at TTSH, described chronic pain as the possible result of a “short circuit” in the body’s pain mechanism system.

Although the original cause of the pain might no longer exist, the nerves at that location may have become oversensitive and can react to the slightest stimulus.

Patients who do not find relief from medical intervention, like surgery or drugs, may be referred to a psychotherapist to help them cope with their pain.

Psychotherapy has, over the past 10 years, become an important part of pain management techniques here, said Dr Poon Keah How, a consultant at the pain management clinic at the department of anaesthesia, National University Hospital (NUH).

The aim of psychotherapy is to get patients to a functional stage, even if the pain persists, said Ms Yang.

Functional pain means that the patient is able to manage his or her pain effectively such that it does not interfere with daily living.

Chronic pain patients often have negative thoughts about their condition.

They may think that they are alone in their suffering or that the pain will incapacitate them.

When they allow their thoughts to be controlled by such pain, which can be severe, they may feel helpless, isolated and depressed.

This is where a branch of psychotherapy, called cognitive behavioural therapy (CBT), can be tapped to counteract such thoughts. It involves a multi-disciplinary team including pain specialists, nurse clinicians, psychologists and physiotherapists.

Under CBT, the patient is made aware of the cause of his affliction and how self-management strategies, like relaxation techniques and stretching exercises, can help him better cope with his pain.

Patients will also be typically asked to record their thoughts on their pain condition, said Ms Yang.

They are then asked, usually by the attending psychologists and counsellors, to consider if their negative thoughts are realistic. “For example, a patient may say, ‘The pain is going to kill me’. We will then ask if there is any evidence that the pain is fatal. Usually, there is not,” she said.

Patients also learn to control how they choose to react to their negative thoughts.

The patient in the previous example may learn to say: “Yes, the pain is bad, but I am able to manage it because it has happened to me before and I have survived.” Psychotherapy – in the hands of well-trained staff – is generally safe, with few risks, said Dr Poon. “As part of the process may involve confronting unpleasant thoughts, there may be temporary distress.

However, a skilled therapist should be able to address this,” he said.

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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.