Pain resulting from physical injury or illness that lasts longer than 6 months is considered chronic pain and is very difficult to “cure”. In fact the medical interventions and medications used to treat pain can create new problems. It is not uncommon for individuals who have chronic pain to develop additional health problems, insomnia, depression, anxiety, social phobia, relationship problems, addiction and financial problems. Each additional issue aggravates other areas of functioning and one is left feeling stuck and hopeless… and in a worsened state of chronic pain and disability.
Chronic pain is a bio-psychosocial phenomenon and thus all of the related issues must be addressed in order to successfully manage the pain syndrome. In cognitive behavioral therapy for pain management we will examine nearly every aspect of your life including what triggers your pain and patterns of distress. We will look at what you eat and drink, how you sleep, your social and spiritual support, and your physical activity level. We will explore your beliefs about yourself and your situation. I will teach you techniques using breathing and imagination to help you manage your physical pain and psychological distress. It is very likely that you will need to make lifestyle changes in order to manage your pain. Some of these changes will be difficult to make. On the other hand, positive lifestyle changes often catalyze other positive changes in your life that might surprise you.
Workers’ compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment. I frequently work with individuals who have been hurt while working. Sometimes after a delayed recovery, individuals develop symptoms of depression, anxiety and insomnia. These psychological symptoms, if left untreated, are likely to interfere with the rehabilitation from injury and adjustment to work-related losses.
In the most serious work injuries, those in which individuals are exposed to life threatening events, Posttraumatic Stress Disorder can sometimes develop. Anyone who has been exposed to such trauma should be carefully evaluated for the development of symptoms of distress including flashbacks, nightmares, phobias, avoidance of people and places related to the event, isolation, depression and substance abuse. These psychological symptoms can be treated with psychotherapy and medication.
I play two different roles within the workers’ compensations system. The most common one is that of a treating psychologist. Occasionally I am requested to act as an Agreed Medical Evaluator (AME). AMEs formally and comprehensively evaluate injured workers and provide input used to resolve medical/legal issues. I will never serve as an AME for someone that I am treating. These are two separate roles with separate functions.
EMDR is a therapeutic tool for treating a number of trauma-related disorders. Originally discovered and developed by psychologist Francine Shapiro in the 1980s, it has been well-researched and endorsed as a modality of treatment that is relatively quick and effective.
During EMDR the therapist guides the client through a specific protocol for processing trauma while simultaneously applying bilateral stimulation. Bilateral stimulation was originally achieved by having the patient shift their eyes from left to right. Now tapping and/or machine aids are also used to create the same effect. The exact mechanism responsible for the efficacy of EMDR is unknown. It is believed that traumatic experiences along with their associated images, emotions and bodily sensation get locked in the nervous system. These “knots” of traumatic data can lie dormant only to be retriggered later. They can also distort the lens through which the affected individual views the world, leading to dysfunctional behavior. Through EMDR these locked-in traumatic experiences can be released and reprocessed. Upon completion of a series of effective EMDR sessions clients report being unburdened by the weight of the trauma. They often report a new, more compassionate understanding of the event and a positive shift in their self-image.
