The Seemingly Strange Behaviour of Chronic Pain Clients

This article looks at several reasons why chronic pain patients may not approach a psychologist for help, and/or may not return for more sessions to support or assist them.

Given that most studies put the prevalence of chronic pain at around 20% of the population, and many experts both working at the coalface and working with health statistics, agree that some 80% of those people are not being helped by current treatment (meta analysis journal “Pain”), this means that some 3 million Australians are right now struggling with no relief, and some 1.5 billion world wide.

Why are they not beating down your door for help?

Doctors aren’t referring

Firstly not many sufferers are being referred to a psychologist. Psychology referrals tend to be a last resort when their doctor or pain specialist has tried every medication or combination they can think of, and not been able to achieve relief. By this point, frustrated by failure, their doctor will imply that the pain is in their head, or that they have some emotional/personality flaw that is making the pain worse.

Occasionally the doctor will recognise that at least the person needs professional support to cope with their chronic illness.

Few doctors understand the benefit of early referral, and realistically, doctor referrals probably only account for some 10% of potential clients for you. In the case of chronic pain, this may only be 1% or less.

Most chronic pain patients don’t even realise that you could help them

Chronic pain is very real and obviously very physical. Psychology simply isn’t something that most people realise is appropriate for this type of disorder. This is why we’ll be developing a range of educational marketing material that psychologists can use to get that all-important information out there.

So many people are in desperate need of your help.

Even when they realise you can help, they don’t actually come to you directly because of the pain

It used to puzzle me that people would sit on my therapy couch and tell me they’d suffered for years without doing anything about it. Similarly when they’d get solid reduction in their pain in the first session but wouldn’t return. I admit the question “are they nuts?” frequently went through my mind.

Perhaps you already have some insight into this one?

The thing is, they don’t come along in the first place directly because of the pain – they come because the pain has got to the point where it’s stopped them from doing something they love, or is endangering relationships with friends or family or their partner, or is preventing sleep to the point of total exhaustion, for example.

Without a strong commitment to seeing through their pain program, as soon as their pain drops below that critical point where it’s having that effect, they will feel no reason to return for further treatment. They simply won’t have the motivation to do so, and will continue to put up with the pain as long as it doesn’t interfere with their life beyond that certain point.

I don’t know, maybe that fits solidly with your view of what therapy is about, maintaining client sovereignty over their own life and decisions, but for myself I haven’t come to terms with giving people results that I think of as half baked.

So how do we resolve this tendency to quit therapy prematurely, and ensure more people are helped to a greater extent

We must of course utilise therapy techniques that actually switch off the pain, rather than focus on helping the person merely to live with or manage their pain. SDR therapy (Sensory Disruption of Reconsolidation) does exactly that, by extinguishing pain signalling.

Rather than depending upon doctor referrals, it’s vital to get interesting, relevant, educational material out to the general public in order to engage with the massive number of sufferers who have given up on and are now outside of medical care. Obviously this won’t be primarily about pain relief, but about benefits of, for example:

• Playing golf again
• Being able to go to events with friends and family
• Being able to spend quality time with family
• Being able to sleep soundly again

We need to learn to have “retention conversations” with the client from the beginning and continuing throughout their treatment program, so that they continue with us until they get the maximum pain relief possible, always aiming for zero pain, with hopefully no more need for medication, no flaring, and as great a return to normal role as full physical recovery will allow.

In order to enjoy a greater flow of referrals from doctors, it’s vital to stay in touch with the pain team, regularly reporting data from your client’s pain program and ensure that the improvements are graphically charted for maximum impact, as well as telling the client’s “story”.

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