Pain managementIn Psychology

PREPARED BY
UNDER SUPERVISION OF
Noora Nasser al-Qadi
DR. DORIA HASSAN
wafa helial al-Gabri
OUTLINE
INTRODUCTION
DEFINITION
TYPE OF PAIN IN PSYCHATRIC PAITIENT
CAUSES OF PAIN IN PSYCHATRIC PATIENT
METHODOLOGY
SOME KEY CONSIDERATIONS
PHARMACOLOGICAL APPROCH
NON- PHARMALOGICAL APPROCH
NURSING CARE PLAN
CONCLUSION
REFERENCES
 PAIN MANGMENT
INTRODUCTION

Pain management in psychology focuses on addressing

the emotional, cognitive, and behavioral aspects of pain.
It’s particularly important because pain is not just a
physical experience—it also involves psychological
processes that can influence its intensity, duration, and
impact on daily life. Psychological interventions for pain
management aim to reduce suffering, improve
functioning, and enhance overall quality of life
 PAIN MANGMENT
Pain management in psychiatric illness is complex because physical
pain and psychiatric disorders often have a bidirectional
relationship. Chronic pain can exacerbate psychiatric symptoms,
while psychiatric conditions like depression, anxiety, or PTSD can
heighten the perception of pain. A multidisciplinary, patient-
centered approach is essential, involving pharmacological,
psychological, and behavioral strategies.

Nursing Assessment:
Evaluate both physical and emotional aspects of pain.
Assess for co-occurring psychiatric conditions, including
depression, anxiety, somatic symptom disorders, or trauma
history.
Consider the impact of pain on functioning, quality of life, and
treatment adherence
 Pain Management in Psychiatric illness
“pain” can extend beyond physical discomfort to encompass emotional, psychological, and even existential
suffering. It often manifests in several forms:

1. Emotional Pain:
Feelings such as deep sadness, grief, hopelessness, or guilt, often seen in conditions like depression, anxiety, and
bipolar disorder.
2. Psychological Pain:
This involves a sense of mental anguish, distress, or inner turmoil that can stem from intrusive thoughts, trauma, or
feelings of inadequacy. It can be particularly intense in disorders like PTSD or OCD.
3. Social Pain:
Feelings of rejection, isolation, or loneliness that result from strained or lost relationships. This is common in people
with conditions like social anxiety or borderline personality disorder.
4. Existential Pain:
This refers to a sense of meaninglessness or despair about life or existence, often present in severe depression or
existential crises.
5. Psychosomatic Pain:
In some cases, mental illnesses can contribute to physical pain or amplify its perception. Conditions like somatic
symptom disorder or fibromyalgia highlight the close link between mental health and physical sensations.
 TYPE OF PAIN IN PSYCHATRIC PATIENT

1- Cognitive Pain:
This involves overwhelming and distressing thought patterns such as rumination, intrusive thoughts, or
self-critical thinking. Cognitive pain is a hallmark of disorders like anxiety, depression, and obsessive-
compulsive disorder.
2- Physical Pain Linked to Mental Illness:
Mental health conditions, such as depression, anxiety, or PTSD, are often accompanied by unexplained
physical symptoms, including headaches, muscle tension, stomachaches, or chronic pain.
3- Spiritual Pain:
This is the suffering that arises when individuals feel a disconnect from their sense of purpose, faith, or
moral compass. It can appear in individuals struggling with identity, existential questions, or a loss of
meaning, often seen in major depression or after traumatic events.
CAUSES OF PAIN IN PSYCHATRIC PATIENT

1- Biological Factors
2- Neurochemical imbalances (e.g., serotonin, dopamine, or GABA dysfunction).
3- Chronic activation of the stress response system (HPA axis dysregulation).
4- Genetic predispositions that increase sensitivity to emotional or physical pain.
5- Psychological Factors:
6-Traumas, unresolved grief, or chronic emotional neglect.
7- Maladaptive coping mechanisms, such as avoidance or denial.
8- Social and Environmental Factors:
9- Experiences of discrimination, marginalization, or lack of social support.
10-Loss of a significant relationship, job, or status.
11- Ongoing life stressors such as financial instability or caregiving burdens.
 Methodology
1. Cognitive-Behavioral Therapy (CBT)
• Focus:
Changing unhelpful thoughts and behaviors related to pain.
• Techniques:
• Challenging catastrophic thinking (e.g., “I’ll never feel better”).
• Developing coping strategies.
• Engaging in pacing activities to avoid overexertion or inactivity.

2. Mindfulness and Meditation

Focus:
Increasing awareness and acceptance of pain without judgment.
Benefits:
Helps patients shift focus from resisting pain to observing it, reducing the
emotional distress associated with pain.
 Methodology
3. Biofeedback
Focus:
Teaching individuals to control physiological functions like heart rate,
muscle tension, and breathing.
Process:
Patients learn to identify and relax tense muscles, which can alleviate
pain, particularly in conditions like migraines or chronic back pain.

4. Acceptance and Commitment Therapy (ACT)

Focus:
Encouraging acceptance of pain while committing to values-based
actions.
Core Idea:
Pain is part of life, but suffering arises when we resist or avoid it.
 Methodology
6. Behavioral Activation
Focus:
Using guided relaxation and focused attention to change the perception of
pain.
Effectiveness:
Particularly useful for conditions like fibromyalgia, arthritis, and post-
surgical pain.

7. Support Groups and Counseling

Focus:
Providing emotional support and reducing feelings of isolation.
• Benefits:
Sharing experiences with others facing similar challenges can enhance
coping and resilience.
 Methodology
8. Psychoeducation
Focus:
Helping patients understand the nature of pain, how stress and emotions
can amplify it, and how psychological strategies can help.

9. Stress Management Techniques

Focus:
Reducing stress to minimize its impact on pain perception.
• Examples:
Progressive muscle relaxation, guided imagery, and deep breathing
exercises.
 Methodology

10. Imagery and Visualization

Focus:
Using mental imagery to create a sense of relaxation or “distance” from
the pain.
• Techniques:
Visualizing a soothing environment or imagining the pain decreasing in
intensity
Psychologists often work in multidisciplinary
teams with physicians, physical therapists, and
other healthcare professionals to create a
holistic pain management plan. These
approaches are especially beneficial for chronic
pain conditions, where the pain persists even
after the physical cause has been addressed.

Pain management in patients with mental illness

is a complex but critical aspect of care. These
individuals often experience pain differently due
to their mental health conditions, medications,
and overall perception of well-being. Effective
pain management requires a multidisciplinary,
individualized approach that considers both their
physical and psychological needs.
 some key considerations:

1.⁠⁠Understanding the Relationship Between Pain and

Mental Health

Comorbidity:
Chronic pain and mental illnesses (such as depression,
anxiety, or PTSD) often co-occur, creating a cycle where
one exacerbates the other.
Perception of Pain:
Mental health conditions can influence pain perception,
with heightened sensitivity in some cases (e.g.,
fibromyalgia) or diminished reporting in others (due to
emotional blunting).
2.⁠⁠Assessment of Pain
• Use validated pain scales and tools tailored to
individuals with mental illness.
• Assess the impact of pain on daily functioning, mood,
and quality of life.
• Consider potential communication barriers, particularly
in patients with conditions like schizophrenia or cognitive
impairments.

3.⁠⁠Multimodal Pain Management

A combination of pharmacological and non-

pharmacological approaches is often most effective.
 4.⁠⁠Addressing Mental Health Simultaneously
• Treating the underlying mental illness can often
improve pain perception and tolerance.
• Maintain close coordination between psychiatrists,
psychologists, and pain management specialists.

5.⁠⁠Avoid Stigmatization
• Ensure that reports of pain from mentally ill patients are
taken seriously. Stigma can lead to under-treatment or
mismanagement.
 6.⁠⁠Monitoring and Follow-Up
• Regularly review treatment efficacy and side effects.
• Monitor for signs of medication misuse or worsening
mental health symptoms.

7.⁠⁠Caregiver and Family Involvement

• Educate caregivers about the interaction between pain and
mental health.
• Support networks can help reinforce coping strategies and
adherence to treatment plans.
Pharmacological Approaches
Analgesics:
Start with non-opioid medications like acetaminophen or NSAIDs when
appropriate. Avoid over-reliance on opioids due to the risk of addiction
and worsening mental health symptoms.
Adjuvant Medications:
Antidepressants (e.g., SNRIs, TCAs) and anticonvulsants (e.g., gabapentin,
pregabalin) are often effective for neuropathic pain.
Cautious Medication Use:
Consider interactions with psychotropic drugs. Monitor for side effects that
might exacerbate mental health symptoms (e.g., sedation or agitation).
 Non-Pharmacological Approaches
• Psychotherapy:
Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment
Therapy (ACT) can help patients reframe their pain experiences and
develop coping mechanisms.
• Physical Therapy:
Gradual and guided movement therapy to address the physical
components of pain.
• Mindfulness and Relaxation Techniques:
Practices like meditation, yoga, and deep breathing can reduce both
physical pain and psychological distress.
• Alternative Therapies:
Acupuncture, massage therapy, or biofeedback may benefit some
patients
 Nursing care plan :-
⁠Assessment
• Pain Assessment:
Use a validated pain scale (e.g., Numerical Rating Scale, Visual Analog Scale,
or Wong-Baker Faces Scale) to assess pain intensity.
• Document the type, location, duration, and triggers of pain.
• Psychiatric Assessment:
Evaluate the patient for depression, anxiety, or other mental health conditions
that may influence pain perception.
• Observe for non-verbal cues of pain or distress,
especially in patients who struggle to verbalize their feelings.
• Functional Impact:
Assess how pain affects daily activities, sleep, and overall quality of life.
• Medication and Substance Use:
Review current medications and screen for potential misuse or contraindications.
• Coping Strategies:
Determine the patient’s current coping mechanisms and social support.
Nursing care plan :-
planning

1- Collaborate with the healthcare team to develop a pain management plan that
integrates physical and mental health needs.

2- Prioritize non-pharmacological and low-risk interventions before escalating to

pharmacological measures.

3- Educate patients on realistic pain management goals (e.g., reducing pain to a

manageable level rather than complete elimination).
 Nursing care plan :-
Intervention
• Administer prescribed medications, ensuring they align with the patient’s psychiatric and
pain management needs.
• Monitor for side effects, particularly sedation, respiratory depression, or potential for
misuse (e.g., opioids, benzodiazepines).
• Encourage adherence to medication regimens for both pain and psychiatric treatment
• Use therapeutic communication to validate the patient’s pain and emotional experience.
• Provide reassurance and a calming environment to reduce anxiety or agitation.
• Guide the patient in relaxation techniques, such as deep breathing, guided imagery, or
progressive muscle relaxation.
• Apply heat or cold therapy if appropriate.
• Encourage light physical activity or positioning changes to improve mobility and reduce
pain.
• Encourage participation in support groups or therapy sessions.
• Involve family members or caregivers in the care plan, with the patient’s consent.
• Mind-Body Approaches:
• Teach mindfulness, meditation, or yoga for stress and pain relief.
Nursing care plan :-
EVALUATION
1- Regularly reassess the patient’s pain level, functional status,
and emotional well-being.
2- Monitor for signs of medication misuse, withdrawal,
or adverse reactions.
3- Evaluate the effectiveness of interventions and
adjust the care plan as needed.
4- Document outcomes and report any significant changes
to the healthcare team.
 Health Education
• Teach patients about the link between mental health and pain, emphasizing the importance
of managing both conditions.
• Educate on medication use, including potential side effects and the importance of
adherence.
• Provide information on lifestyle changes (e.g., exercise, diet, stress reduction) that can help
alleviate pain and psychiatric symptoms.

• Advocate for the patient’s needs, ensuring access to multidisciplinary care, including
mental health and pain specialists.
• Address potential stigma related to psychiatric illness and pain to foster trust and
encourage engagement in care.
 Conclusion
Understanding the deep connection between chronic pain and mental
health unveils a pathway to holistic care. By recognizing how pain affects
emotions and vice versa, we pave the way for integrated treatments that
address both physical discomfort and psychological distress. With
collaborative efforts and personalized approaches, we can improve the
well-being of individuals living with chronic pain, enhancing their quality of
life and promoting resilience.
References

Grand Rounds, NYU Pain Management Division, NYU Langone Medical

Center Sept. 25, 2012
Matthew B. Smith, M.D. Faculty, NYU School of Medicine General Adult
psychiatry Liaison Psychiatrist, NYU Pain Management Team Liaison
Psychiatrist, NYU Palliative Care Team ©Matthew B. Smith 2012
Thank you