Psychology


Chronic Pain

Problem description

Pain that persists beyond the usual time of healing or recovery from injury or illness is usually categorized as chronic. Chronic pain may be associated with an illness or injury, or may start as brief episodes that become more frequent and constant over time. Different types of chronic pain include low back pain, migraine or tension headache, post-surgical pain, fibromyalgia, and various nerve-related pain conditions (e.g, trigeminal neuralgia, postherpetic neuralgia, and regional pain syndromes). Most chronic pain conditions cannot be ‘cured’ or resolved, so the focus is on managing pain and improving daily functioning and quality of life.

Services available

Psychological assessment and treatment for chronic pain are primarily available to patients being seen through the WRHA Pain Clinics (Pan Am Pain Clinic and Health Sciences Pain Management Centre sites). The psychologists in the Pain Clinic sites work closely with anesthesiologists and other pain physicians, as well as nursing and physiotherapy professionals.  The psychologists provide:

  1. Pain self-management group education classes (2 sessions).
  2. Psychological evaluation to determine appropriateness of a behavioral treatment approach for chronic pain.
  3. Pre-surgical assessment for surgically-implanted pain-modifying devices.
  4. Behavioural pain management groups based on a cognitive behaviour therapy (CBT) or acceptance-based behaviour therapy (ABBT) approach.  The groups are facilitated by one or two psychologists and typical enrollment is 8 to 10 individuals.
  5. Individual therapy may be offered emphasizing the development of pain-coping or acceptance-based behavioural strategies.
There is some availability of behavioral pain management services for individuals other than those being treated through the WRHA Pain Clinics.  Those with disease-related pain who may not be candidates for the WRHA Pain Clinic can be referred directly to the Clinical Health Psychology Program.  However, the availability of services is limited in this setting.  

Description of services and treatment

Cognitive-behavioural therapy (CBT) and acceptance-based behavioural therapy (ABBT) have been shown to be effective treatments for people living with chronic pain. CBT-based interventions provide individuals with active coping strategies that can change the pain signal, reduce stress that may exacerbate pain, increase activity level, reduce emotional distress, and improve quality of life. Treatment may involve pain education to assist patients in understanding their condition, monitoring of pain to identify pain triggers, identifying and changing negative thinking, improving pain communication skills, and relaxation training. 

ABBT-based interventions are primarily experiential and much of this experiential learning occurs by contacting and relating to metaphors and through various forms of mindfulness meditation. In this approach, unworkable habits and strategies are identified and discarded in order to learn new psychological skills for reducing the impact and influence of painful sensations, thoughts, and feelings on our daily functioning. ABBT also involves clarifying what is truly important and meaningful to us, that is, what we value, and using that knowledge to guide, inspire, and motivate us to set goals and take action that enriches our life.

Key Providers

Dr. Brigitte Sabourin, PhD, C. Psych. Candidate (Health Sciences Centre)
Dr. Gregg Tkachuk, PhD, C. Psych. (Pan Am Pain Clinic)

Sites

Health Sciences Centre Pain Management Centre
Phone:  204-787-3018

Clinical Health Psychology Program, Health Sciences Centre
Phone:  204-787-7424 (CHP General Office)

Pan Am Pain Clinic 
Phone:  204-927-2609

Availability

Pain Self-Management Group Education Classes (2 sessions): offered several times per year.

Behavioral Pain Management Groups (6 sessions): offered several times per year, usually starting in January, April and September. 

Referral process

Referral from a family physician or physician specialist to the Pain Clinic; if patient is not a candidate for the Pain Clinic services, a referral may be considered to the Clinical Health Psychology Program. Those with active claim files for injury or disability (e.g., Workers’ Compensation Board, Manitoba Public Insurance) are not typically seen through these WRHA services, but they can obtain psychological care through licensed psychologists in the community.  See Manitoba Psychological Society for a directory at http://www.mps.ca/

Link to other resources

Canadian Psychological Association fact sheets on effectiveness of psychological treatments:

The Canadian Pain Coalition Pain Resource Centre provides information on psychological coping strategies within an interdisciplinary approach to care:

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