Promising psychosocial treatments for pain in MS

For some people with MS, medicines can provide complete relief from pain,but many pain sufferers do not achieve adequate pain relief by pharmacological means. Fortunately, a number of non-pharmacological approaches can be used that have been proven to be effective in other groups of people with chronic pain.

The biopsychosocial model of pain

The experience of pain is very complex, involving not only the body but also the mind. Current thinking is that chronic pain is best understood from a biopsychosocial perspective, which recognises the importance of the underlying biological basis of pain (for example, nerve damage due to MS), but  also acknowledges that psychosocial factors may have a significant impact on the experience of pain and its effects on life.

Some of these factors include one’s emotional reactions to pain and how one thinks about or deals with pain. The biopsychosocial model has led to treatments that are effective for decreasing pain severity and the negative impact of pain.

People with pain sometimes worry that others think that their pain is “not real”, exaggerated, or a sign of mental illness. On the contrary, chronic pain is a serious condition that is “in one’s head” only because pain signals are processed in the brain. Advances in brain science have confirmed that psychological factors such as one’s emotions or stress can affect physical health, including pain. Living with MS and pain can also cause chronic stress. The brain (mind) and body influence one another in ways that science is just beginning to understand.

Relaxation training

Pain and other stressors often result in a natural response of repeated and prolonged tensing of muscles, which tends to worsen pain. Research has shown that one of the best ways to counteract the tensing effects of pain and stress is to practice various forms of relaxation. There are many methods to achieve relaxation – deep breathing, baths, music, meditation or prayer for example.

Some relaxation strategies can be tried without instruction, whereas others may need to be learned under the guidance of a professional.

People vary in their ability to relax, so trying a variety of relaxation techniques may be necessary to find what works best. Relaxation exercises may also work best when paired with other coping strategies.

Deep breathing is the basis for many relaxation techniques, so it is often a good skill to learn first.

It is generally done lying down or sitting in a comfortable chair. The basic method involves taking a deep breath through the nose, trying to cause a rise in the abdomen, followed by a brief pause, and then exhaling through the mouth. To heighten the sense of relaxation, some people say calming words to themselves, such as “relax” or “peace” on each exhalation. To achieve maximum benefit, deep breathing should be practiced for at least five minutes, several times per day.

Self-hypnosis training

Research published over the past decade supports the benefits of self-hypnosis training for helping individuals better manage both acute and chronic pain. Like relaxation training, self-hypnosis is a way to use the power of the mind to manage pain by altering the experience of pain.

This may include distracting from pain, focusing on more pleasant sensations, or even experiencing pain as decreasing or going away. Contrary to how hypnosis is portrayed in the media, people using self-hypnosis always remain in control of themselves. Training in self-hypnosis should be done with a professional experienced in its use for pain. It can often be learned in only a few sessions and should be practiced regularly to maintain benefits.

Like medications, self-hypnosis training rarely, if ever, eliminates pain completely; nor does it benefit everyone who tries it. However, there appears to be a subgroup of individuals, including those with MS, who report substantial decreases in pain severity following self-hypnosis treatment and who are able to maintain this improvement over time. In addition, unlike some medications, the “side-effects” of self-hypnosis training are positive. For example, in a study that included people with MS, 40 different benefits of self-hypnosis were identified in addition to pain relief and no negative effects were reported.

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Cognitive behavioural therapy

Numerous studies indicate that the way people think can have a big impact on how much pain they experience, how they deal with pain, and how much pain interferes with their lives and functioning. Things people do to cope with their pain can also be helpful (for example, using relaxation techniques) or unhelpful (for example, using alcohol excessively to relieve pain).

Cognitive behavioural therapy (CBT) involves teaching people how to change their pain-related thoughts and behaviours in order to reduce pain and its associated suffering. In CBT, individuals are taught to examine the thoughts they have about pain, determine whether these thoughts are helpful or unhelpful, and replace any unhelpful thoughts with helpful, reassuring ones.

CBT often also includes teaching other pain management techniques such as relaxation training, distraction techniques, or activity scheduling. It typically involves either group or individual treatment by a professional with expertise in CBT, and optimally, pain.

Other psychological interventions

Other psychological treatments may be useful in addressing pain and its impact, including support groups, pain education, and psychotherapy. Treating depression, when present, is recommended, given that depression and pain often impact one another. Physical exercise (for example, walking, swimming, or yoga) often has beneficial effects not only on a person’s physical condition but also on pain and stress.

How to find help

Unfortunately, many people with MS pain are offered these treatments only after all medical treatments have been tried and failed. Psychological interventions should be considered early, soon after the development of pain, along with other appropriate and effective treatments such as medications or rehabilitation. The sooner these treatments are used, the more likely they are to be of benefit. For those who do not have access to specialists in the psychological treatment of pain, text and web-based resources may be available from your national MS society, or via your nurse or doctor.

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