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Psychologist
specializes in pain management
(July
2007 Issue)
The connection between psychology and traditional medicine is ever-expanding.
There is no greater example of this than in the field of pain management.
The psychology of pain, a field in which new discoveries are announced
at an alarming pace, is a prime example of how varied disciplines
can work together with great results.
According to the American Pain Association, pain is the "leading
public health problem in this country… [and] results in more than
50 million lost workdays each year." Dealing with the management
of pain, both pharmacologically and through clinical treatment,
professionals in the field can work together to identify underlying
causes of pain and strive to release the stress and tensions that
often exacerbate the experience of pain.
Jonathan Borkum, Ph.D., is a clinical psychologist specializing
in health psychology with Health Psych Maine, in Waterville and
Bangor, Maine, and a faculty associate at the University of Maine
in the psychology department. He and his partners at Health Psych
offer treatment for what they call "mind-body" problems, including
pain management and anxiety disorders.
Published in April, Borkum's new book "Chronic Headaches: Biology,
Psychology, and Behavioral Treatment" has been called the definitive
book on the treatment of debilitating headache pain from a bio-psychological
perspective. The book provides a comprehensive review of the latest
theory, research, and treatment of chronic headaches.
Borkum spoke with New England Psychologist's Catherine Robertson
Souter about his work in the field of pain and the reception his
new book has received.
Q: How did you decide to write your book?
A: In 1986, when I started in the chronic pain field, the profession
knew little about pain and I personally knew vastly less. I really
felt a need to get a better grounding in pain and the book was my
attempt to do that.
Q: The book went out for peer review. How was it received by
your colleagues in the field?
A: Remarkably well, which says something about this field. Not
only did the reviewers not know who I was, they didn't know anyone
who knew who I was. I hadn't studied with them or researched with
them. I came from out of nowhere from their perspective and yet
I was purporting to write the text of their field. They welcomed
it warmly which speaks volumes to their integrity and their belief
in their field. They want this field to develop and whoever helps
to do that has their support.
Q: Do you plan to write a follow up?
A: Well, the book came out on April 12 and there have been some
very exciting discoveries in the field since then. The version on
my word processor needs to be updated weekly.
Q: Define 'health psychology' for us.
A: Health psychology is the application of clinical psychology
tools in assessment and treatment to improve physical health. It
can cover anything from the communication between a physician and
patient, to adherence to necessary treatments, to my own area, which
is the promotion of self-management of chronic diseases, pain in
particular.
Q: What types of issues do people you work with have?
A: It can run a gamut of pain producing causes. There are people
who have had multiple back surgeries or people who have developed
fibromyalgia or widespread muscular pain following injury or psychological
trauma, people with high chronic headaches, migraines, post traumatic
head injuries, chronic whiplash, chronic shoulder pain from injury
or from repetitive motion.
Q: How do you treat them?
A: It depends on the disorder. Some disorders are stress sensitive,
the pain is intensified by the level of adrenaline in the blood
stream. That doesn't mean stress causes these disorders. The causality
is much more complicated than that. But in treating these disorders,
we are always looking for the part of the problem that can be under
patient control. So if a disorder is stress sensitive, that is a
good thing because that means we can control the pain to a degree
through relaxation skills and stress management skills.
Q: Do you work closely with a medical practice?
A: At Health Psych Maine we have three clinical psychologists
and a clinical social worker. We do not have physicians under the
same business entity but we collaborate with them very closely in
patient care. We try to create a multidisciplinary approach, to
work as a team without walls My own area is largely in chronic pain
management. Broadly put, I try to bring about a figure ground shift
so that people for whom pain has been a large part of their lives
psychologically remember the rest of their lives, what is important
to them and I would hope deeply involved in those other areas that
are important to them.
Q: Does re-focusing on the rest of your life also reduce the
pain?
A: Yes, even that one tool helps. One of the purposes of our
built-in pain control pathways in the nervous system is to reduce
pain at all levels of the nervous system when we are involved in
something that is more important than the pain.
Q: Is it like giving a lollipop to a child when they get a shot?
A: A lollipop works but for a different reason. It gives you
a sweet sensation, which actually reduces the pain, particularly
with people with low blood pressure, interestingly. People with
low blood pressure tend to have lower activity in their endorphin
system. Low blood pressure is wonderful for preventing heart disease
and stroke but it is a risk factor for chronic pain.
Q: There is a lot more to this field than one might imagine.
A: What you see is a hint of the huge progress that has been
made in understanding the wiring, the neuro-physiology that underlies
the transition from acute to chronic pain. It is a fascinating story
in its own right. It is a field in which one can begin to see clinical
psychology through the lens of central nervous system functioning.
The science is impelling us in that direction or permitting us to
move in that direction. The potential for psychology to make a favorable
impact beyond medications and procedures is very strong. And my
sense is that to this day, people with chronic pain tend to remain
underserved.
Q: Is this the future of health care, this close collaboration
between psychology and the medical field?
A: I think it is pragmatically, in terms of the impact on patients'
well-being. It is also intellectually compelling for psychologists
to work closely with physicians. There is just so much we can learn
from each other. Physicians look for specificity in the pain - to
understand the pain in terms of a structural lesion, a ruptured
disk or scar tissue around a nerve in the spine but one can also
achieve understanding and control over the pain by looking at the
conditions that worsen it and those that improve it and the variables
that mediate the effects on someone's life. As people learn about
this field, they will discover how incredibly common and intrusive
and disabling pain problems are.
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