Control pain through thought and behaviour

Patients can now go to "school" to learn how to cope with pain using cognitive behavioural therapy, when other treatments fail.

It is an increasingly recognised way to manage pain, and both Singapore General Hospital (SGH) and National University Hospital (NUH) have started using it to help patients with chronic pain.

The therapy is based on the notion that thought and behaviour can influence symptoms and disability, said Dr Tan Kian Hian, director of the pain management centre, and senior consultant at the department of anaesthesiology, in SGH.

The therapy has three parts. The first helps patients to understand how thought and behaviour can influence their pain experiences and emphasises the role they play in controlling their own pain, he said.

The second equips patients with coping skills - they are taught a variety of cognitive and behavioural coping strategies for pain.

Dr James Tan, senior consultant at the pain management clinic in NUH, explained that if, for instance, a librarian found it hard to stand for too long, he could tailor his job in such a way that he could sit some of the time, by staggering duties which require standing with those for which he can sit.

The third part of cognitive behavioural therapy entails the application and maintenance of the coping skills that one has learnt.

At SGH, patients can opt for a four-day programme. So far, 10 patients have been on it and all have reported better pain management.

They are more confident in carrying out activities despite their pain, said Dr Tan Kian Hian.

They also have fewer negative thoughts, less pain and pain distress levels, as well as less depression, anxiety and stress, he added.

There is no formal programme at NUH, but the hospital has a multi-disciplinary team - which includes acupuncturists, psychologists, physiotherapists, nurses and doctors - to help patients.

"A huge part of therapy is to teach patients that having pain does not mean that they cannot have a functional life," said Dr James Tan.

Often, they can modify their work and expectations. They are also taught techniques to counter pain, such as relaxation therapy.

When one is in pain, a natural reaction is to breathe faster. This, however, causes one's blood pressure to rise.

To counter that, the person can do deep-breathing exercises to help him to relax and reduce the distress caused by the pain, said Dr James Tan.

STUDY ON PAIN

To help patients better, the SGH pain management centre is embarking on a study to document all the patients seen at the centre and the kinds of pain they have.

They will be evaluated through a questionnaire which takes into account the impact of pain on their quality of life and activities of daily living, said Dr Tan Kian Hian.

It will start as a one-month pilot project. "It will be the first study of its kind," he said.

The results will help doctors to better understand the different kinds of pain experienced by patients and how their life is affected.

"Hopefully, with better pain management, patients can have an improved quality of life," said SGH's Dr Tan.

This article was first published on July 14, 2015.
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