Psychological interventions for chronic pain management from a biopsychological perspective requires an integrative and interdisciplinary approach. 

Clinically speaking, the experience of an individual’s level of pain incorporates their physiological state, thought patterns, emotions, behaviors, and sociocultural construct. Researchers Roditi, D. & Robinson, M. (2011) state that “…psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.”

In their research findings Roditi, D. & Robinson, M. (2011) identified multiple influences that impact how a person experiences their chronic pain. They point out that it’s both personal and subjective. Keeping a focus on the subjective experience is paramount for treatment approaches.

Working clinically with psychological interventions involves focusing on behavioral and cognitive modifications.  This includes interventions designed to increase self-management, improve pain-coping strategies, reduce pain-related disability, and reduce emotional distress. It is not appropriate to works towards eliminating the pain source. “…the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives”, (Roditi & Robinson, 2011).

The National Institute of Nursing Research reports that pain affects more Americans than diabetes, heart disease, and cancer combined. People who suffer from chronic pain are the most common prescribers of medication. Recently the Joint Commission on the Accreditation of Healthcare Organizations required that pain is evaluated as a 5th vital sign. “The IASP’s definition highlights the multidimensional and subjective nature of pain, a complex experience that is unique to each individual”, (Roditi & Robinson, 2011). Part of the complexities of chronic pain comes from the physiological issues that accompany it, the functionality impact it has on a person’s mobility, and the extended period of time that it continues.

Behavioral treatment approaches include:

• Relaxation & meditation training
• Diaphragmatic breathing (deep belly breaths)
• Progressive muscle relaxation
• Autogenic training
• Visualization & guided imagery

References
Roditi, D., & Robinson, M. (2011). The role of psychological interventions in the management of patients with chronic pain. Psychology Research and Behavior Management. Volume 4: pp. 41-49. Doi: 10.2147/PRBM.S15375.
http://www.ncbi.nlm.nih.gov/pubmed/22114534

By: Lisa Lukianoff, Psy.D.

Discoveries in science promote advancements in fields of study. Case-in-point the psychological sciences field is inextricably linked with discoveries in neuroscience.

Neuropsychoanalysis, the clinical practice, and study of neuroscience and psychoanalysis, is an emerging field propelling research in the neuropsychoanalytic study of psychological states from a brain science perspective.

To study the neural patterns of psychodynamic conflict, scientists Kehyayan, Best, Schmeing, Axmacher, & Kessler (2013) used fMRI  scans to measure internal states. The scans revealed psychodynamic conflict in the anterior cingulate cortex and in the emotion-processing regions of the brain.

The concept of “neuropsychoanalysis” joins together psychoanalysis and neuroscience to allow for psychoanalytically informed neuroscience. “…if a theme comprised in the subject’s conflict is touched in a real-life situation, reactions on the behavioral, cognitive, and physiological level should be expected, that call for the regulation of cognitions, impulses and, most importantly, emotions”, (2013).

​Scientists Panksepp & Solms (2012) state that the study and idea of neuropsychoanalysis, which began in the 1990’s, arose from a clinical need to reconcile psychoanalytic and neuroscientific perspectives on emerging discoveries. The overarching goal was to better understand the neurobiological origins of emotions and psychiatric dysfunction. The focus is on brain functions, “Neuropsychoanalysis is especially interested in brain functions that govern instinctual life, in particular, those that are foundational for understanding subjectivity, agency, and intentionality”, (p. 1, 2012).

Ideally, the synthesis of these fields will produce a greater understanding of the neurological brain affective networks involved in psychological states and an understanding of higher cognitive functions.

“Researchers in this field assimilate the best conceptual tools and clinical observations from the pre-neuroscientific era that sought to understand the complexities of human mentation in their own right, and encourage their integrated use with all the new and old neuroscience techniques needed for a fuller understanding of mind than academic psychology and neuroscience has yet achieved”, (Panksepp & Solms, p. 3, 2012).

Based on these findings psychodynamic conflicts viewed by corresponding fMRI studies provide an investigative technique to analyze conflict processing with neuroimaging.

References
Kehyayan, A., Best, K., Schmeing, J. B., Axmacher, N., & Kessler, H. (2013). Neural activity during free association to conflict–related sentences. Frontiers in human neuroscience. Volume 7(705). Doi: 10.3389/fnhum.2013.00705.
http://journal.frontiersin.org/Journal/10.3389/fnhum.2013.00705/abstract

Panksepp, J. & Solms, M. (2012). What is neuropsychoanalysis? Clinically relevant studies of the minded brain. Trends in cognitive sciences. Volume 16(1): pp. 6-8. Doi:10.1016/j.tics.2011.11.005.
http://www.frontiersin.org/publications/22153583