How is pain psychology used in cancer care?

Pain is the body’s warning signal. The brain processes, interprets and uses pain to warn our bodies of danger and threat.  

Unlike your temperature or blood pressure, however, pain can be difficult to measure. Because of this, it can be hard for many individuals to express or get help for their pain. But even though pain isn’t something others can see or calculate, that doesn’t mean it's not real. Pain is a valid symptom our team works hard to treat.

As a pain psychologist at MD Anderson, I am interested in all the pieces that make up a person’s pain experience. 

Ahead, I answer common questions about pain psychology and its role in cancer care.

What is pain psychology? 

In the field of pain psychology, we find ways to help people manage or cope with pain.

Pain can be distressing. In our outpatient clinic, I work mainly with patients who are experiencing chronic pain, or pain that lasts longer than is helpful for our bodies to detect or protect injuries. However, many of the strategies that pain psychologists teach can also be applied for acute, or shorter-term, pain. 

Pain psychology addresses many of the factors that may be contributing to a person’s pain experience. Pain psychologists help people understand how the brain processes pain signals in different situations. For example, imagine stubbing your toe. Ouch, right? Different environments and events might change how you respond to that pain. Stubbing your toe might hurt more when you're already stressed or angry than it would when you are excited or focused on something else. 

Pain psychologists can also help patients navigate and reduce emotional distress. This can help the brain lower the threat level it uses to process pain signaling. This doesn’t mean pain isn’t real or is all in your head, but rather that experience, emotion and stress level can impact how pain is experienced. 

How is pain psychology used in cancer care?

There are a number of pain psychology techniques that can assist patients experiencing pain from cancer symptoms, treatment or side effects.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy can give us a way to understand how thoughts, emotions, behaviors and sensations, like pain, may be connected. In pain management, CBT strategies are used to help calm the brain's fight or flight mode without medications or procedures.  

Some strategies that may be part of cognitive behavioral therapy for pain are:

• Diaphragmatic breathing
• Progressive muscle relaxation
• Guided imagery 
• Mindfulness
• Reframing thought patterns
• Biofeedback 
• Clinical or medical hypnosis 

When patients learn strategies they can use to manage and cope with pain, it can be very empowering and allow patients to feel less helpless about pain.

Managing emotional distress

Pain and mental health are often connected. 

When we’re in pain, it can increase emotions like frustration, sadness and worry. These emotions can increase the threat level in the brain. This can create a loop where pain and emotional distress are making each other worse.  

Pain psychologists can help individuals learn how to manage and decrease this emotional distress, which also helps with managing pain.

Improving quality of life

Psychologists can help those with chronic pain set goals and improve their quality of life. 

For example, maybe a patient really enjoys fishing, but pain is preventing them from fishing regularly. We can talk about what they value most about fishing – whether it be nature, time with family, or quiet reflection – and help them find ways to live out these values. While it may not always look the same as before, we can often help patients restore some function and continue to find meaning in their lives.  

Helping patients and care teams communicate 

Psychologists can help patients talk about their pain experiences so their care team better understands what they are going through.

What happens at a pain psychology appointment? 

MD Anderson patients are referred to Pain Medicine by their care team or can ask their care team for a referral. 

At the first appointment, a pain psychologist meets a patient and sometimes their family. 

We talk about a patient's pain experience, how pain has affected life for them, and how they are doing socially, emotionally and cognitively. Then, we explore how pain psychology might support their pain management plan.

Often, pain psychologists work alongside the pain medicine team to understand a patient's personal pain goal and equip them with multiple tools to manage their pain experience.  

When we treat chronic pain, we also measure success by asking about quality of life, how much a patient can do despite pain or discomfort and how we can continue to bring meaning and value to the things they are pursuing.

Sometimes, patients only have one appointment to help understand their pain experience or to determine if a procedure with their pain physician would be a good option. Other times, they might come back to work on techniques like relaxation training, cognitive skills or clinical hypnosis. Some patients also benefit from longer-term stress management support or supportive therapy for emotional distress.

One of our goals is for patients to feel confident they have pain management strategies – including ones they can use on their own. It can be helpful for patients to know relaxation strategies or different ways to think about pain-related worries so that they can manage pain without medication or other interventions. I think that's important and empowering for people.

What is an example of pain psychology that can be used in daily life? 

Diaphragmatic breathing is a simple strategy that changes the way we breathe. It can help open the lungs and signal our nervous system to dial up our relaxation response.  

Here are some steps to get started:

1. Start by putting one hand on your chest and one hand on your stomach.
2. Next, imagine a balloon in your stomach. As you inhale, imagine filling that balloon up. As you exhale, imagine gently letting the air out. As this happens, the hand on your stomach should be moving up and down. Breathe in through your nose and out through your mouth to deepen your breath.
3. Keep your breath steady by counting at a rhythm that feels comfortable for you. For example, “In-2-3, Out-2-3-4-5.” 
4. Mental images can also help you relax. Visualize what comfort looks like to you as you breathe in. Visualize what relaxation looks like as you breathe out.

As you continue taking in air and filling that balloon up, you might notice your breath reaches lower and gets slower. You might find your body gets more relaxed simply because of the way you are breathing. You might find that discomfort lessens as comfort grows.

Request an appointment at MD Anderson online or call 1-877-632-6789.