The national crisis of opioid addiction has led many doctors and patients to look for alternatives for managing pain.
The Pulse has been exploring some of those alternatives, from Buddhist approaches to acupuncture. This week: how cognitive behavioral therapy is helping two very different groups manage chronic pain.
Brandon Parris is 21 years old. And he has sickle cell disease. That’s a painful blood disorder that affects mostly African Americans.
“I am a student at U Conn, I’m actually in final exams this week.”
We’re on the pediatric hematology-oncology floor at Hartford Children’s Medical Center in Hartford, Connecticut. He’s moving on from years of being treated here, now that he’s an adult. But a doctor here may have equipped Parris with some of the techniques he will need to manage the pain of sickle cell.
“I still use them to this day," says Parris, "such as breathing and putting my mind in a different place so the pain isn’t as bad as it seems.”
The pain of sickle cell disease can be intense. In normal patients, red blood cells are round and soft. They have no problem traveling through the blood vessels and bouncing off the walls of those vessels. I’ll let Parris’ doctor William Zempsky, explain what happens in sickle cell disease: “…the cells are what we’d call sickle shaped, they’re not all perfectly shaped like a sickle, but they’re much stiffer than normal red blood vessels, so they get clogged in the blood vessels.
When those sickled cells get stuck and clog up blood vessels, Zempsky says it’s like having a thousand little heart attacks all over your body. For some, opioid painkillers like OxyContin might help. But Zempsky says as the disease progresses, the kind of pain changes—and what works to treat it changes too.
“Now what we see is these patients transition from intermittent episodes of pain to really chronic pain. And we think there’s a transition where the cause of their pain changes. In chronic pain we think that a lot of their pain is similar to other people with chronic pain. It’s actually mediated by abnormalities in the pain system itself.”
Translation: the body becomes so sensitive to pain that it’s like an over active car alarm, going off at the slightest vibration. Zempsky knew he had to find a new way to treat his sickle cell patients’ chronic pain. And so along with researchers at the University of Washington, he’s studying the effect of something called Cognitive Behavioral Therapy, or CBT, on his teenage patients.
“Cognitive Behavioral Therapy teaches kids strategies to control their pain with their mind. So it looks at cognitions–the way you think about your pain–and tries to change the way kids think about their pain, and the way they act or behave when they experience pain so that their pain has less of an impact on them.”
Zempsky has enrolled about 30 teens to go through one online module a week for eight weeks. They’re learning about breathing, guided imagery, meditation, how to relax before bed, and more. It’s too soon for results, but CBT seems to be helping another group of people with chronic pain – female veterans.
“So the group is called Mind-Body Resilience Training for Women Warriors," says Dr. Lauren Schlanger. She’s an internist at the Providence VA. "And it’s a group that focuses on mind-body skills in order to relieve and improve physical symptoms.”
Schlanger started this group for female veterans with chronic pain to try to teach them some techniques for managing that pain. One of those is a kind of Cognitive Behavioral Therapy, or CBT. Schlanger explains what they do.
“And we go through recognition of feelings in our body that are related to stress in order to increase awareness as to when we are stressed," says Schlanger. "And then looking into what are our thought patterns, particularly the negative automatic thoughts, ways of thinking that are not necessarily accurate, and certainly not helpful.”
And then says Schlanger the group finds new thoughts to replace those negative ones. They use other techniques like mindful breathing or meditation to stay aware of their body, before problems creep up.
Group member Stacy Barton was a Navy nurse. Nursing is physically demanding, and Barton had a particularly stressful deployment – to Guantanamo.
“I was assigned to take care of the detainees as their health care provider. So it was very stressful environment, it was very hostile, it was very scary.”
Add to that the injuries nurses sustain on the job, lifting patients and performing other duties.
“I suffer from fibromyalgia, as well as chronic pain due to a spinal fusion I had in 2004," says Barton. "I also have chronic left hip bursitis type pain. I had my right shoulder repaired twice in three years. It goes on…”
To control that pain, Barton says she’s tried everything: “I’ve tried narcotics, I’ve tried acupuncture, I’ve tried chiropractic therapy.”
Nothing has worked consistently to relieve her pain, so Barton joined this mind-body medicine group to learn some new techniques. Barton thinks of an example of how cognitive behavioral therapy worked on her drive in to the VA this morning. She got stuck behind a school bus. Normally, that would make her stressed, tighten her neck muscles, and trigger pain. But instead, she noticed her response, and re-framed it.
“I’m sitting there behind the school bus, and I had the pleasure of watching this man, he looked like he was a military service person, but disabled, walking with a cane, walking his little child to the bus," Barton says. "That man demonstrated so much love for the little kid getting on the bus, and it was just like wow, if I didn’t stop and pay attention to that, I wouldn’t have seen it. I would have just been Oh, this damn school bus!”
But has any of this helped Barton’s pain? Actually, she says, yes.
“I have gone from taking pain meds and everything else on a daily basis if not more than once a day to I have it maybe once or twice a month," says Barton. "Because I can sit there, relax, I can use other techniques to help me.”
There’s a growing body of evidence that shows Cognitive Behavioral Therapy, or CBT, can be really effective in reducing pain – especially chronic pain. And that could be a boon for people who can’t or don’t want to try addictive opioid painkillers.