Pain management and behavioral therapy

In multimodal pain management approaches, doctors from different areas of specialization – including pain medicine, physiotherapy, occupational therapy and psychotherapy – work closely together. The treatment involves a combination of exercise, patient education, relaxation techniques and medication. Psychotherapists show patients psychological strategies that help them cope with chronic pain and stress at work or home. This is either done in groups or one-on-one sessions.

Multimodal pain management programs are mainly offered by pain centers, psychosomatic medicine departments in hospitals, and rehabilitation centers with a focus on rheumatology, orthopedics and psychosomatic medicine. In some programs you may stay at the hospital or center the whole time, and in others you may have some of the treatments as an outpatient. They last at least seven days, but usually two to four weeks.

The aim of the treatment is to “help people to help themselves” – in other words, learn strategies, exercises and techniques that they can use on their own once they go home.

Multimodal pain management is particularly suitable if other treatments haven’t helped enough or the fibromyalgia symptoms are having a great impact on the person’s quality of life or ability to function in everyday life. In Germany, the treatment can be prescribed by a practice-based doctor such as a family doctor, orthopedist or pain specialist. People generally have to wait about three months before they get a place in a multimodal pain management program.

A lot of people who have fibromyalgia don’t understand how psychotherapy can help them because they think that it’s only used for the treatment of psychological problems. This isn’t true, though. For instance, one type of psychological treatment called cognitive behavioral therapy (CBT) is used in the treatment of tinnitus, sleep problems and various chronic pain syndromes.

Your own thoughts, feelings and behavior greatly influence how you experience chronic pain or other symptoms. For instance, some people find the pain to be far worse on a stressful day at work than they do at the weekend when they’re out and about with good friends.

The aim of cognitive behavioral therapy is to recognize negative thought patterns and behaviors that make the pain worse. You then try to change those thought patterns and behaviors, for instance by questioning the assumptions that the (often automatic) thoughts are based on. Multimodal pain management programs also include various techniques that can help people cope with pain, such as relaxation and stress management techniques, mindfulness training and visualization (guided imagery).

CBT can be particularly helpful in people who live in constant fear of pain, which actually makes the pain worse. It is also especially suitable for people with fibromyalgia who also have an anxiety disorder or depression.