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Psychological Medical Management

Psychological Medical Management is the application of clinical psychology to disorders manifested with physical symptoms, like headaches, insomnia, and chronic pain. In some cases, the disorders involve a significant emotional or stress-related component, which has contributed to the onset of the problem; in many other cases, emotional distress is a consequence of a primary medical problem. Whatever the case might be, we seek to manage symptoms using psychological tools, often in concert with other medical practitioners.

Managing Chronic Pain

The causes of chronic pain range from musculoskeletal disorders (like lower back pain), to malignancy (cancer), injury, severe burns, and arthritis. At times, there may be no apparent cause at all. While acute pain is an indispensable alert that something is wrong and needs your attention, chronic pain continues for weeks, months, or even years. In time, the nervous system itself can change, complicating the original problem. Furthermore, the anxiety and depression resulting from the original problem, and/or the pain that is a symptom of it, have been shown to heighten pain perception.

According to the National Centers for Health Statistics, chronic pain affects over 75 million people in the United States. Back pain is the leading disability in Americans under age 45.

Prescription drugs are often used to treat chronic pain. While offering relief, these painkillers can be addictive; in 2007, 12,000 people died in the United States from unintentional overdose of pain relievers. These drugs also may lose efficacy over time.

Psychological techniques to manage chronic pain include biofeedback. Since pain is a complex sensation, and not purely sensory, biofeedback is used as one of many tools, including Cognitive Behavioral Therapy (CBT), paradoxical relaxation approaches, and Acceptance and Commitment Therapy (ACT)

Managing Migraines

Migraine is characterized by debilitating headaches, lasting from a few hours to a few days, often resulting in nausea, vomiting, and other secondary symptoms. It is about three times as common in women as in men; its causes are unknown, but there is likely a genetic as well as psychosocial component. Tension headaches are much more common than migraines, accounting for nearly 90 percent of all headaches. They are often described as a feeling of constant pressure. Causes are uncertain; theories include muscle tension and chemical errors by the brain's pain filter.

Although the causes of these headaches are unclear, triggers include stress, hunger, lack of sleep, eyestrain, and dehydration. Psychologically managing these triggers can provide significant relief.

  • Biofeedback, which seeks to enhance control of bodily function through managing indicators like blood pressure, heart rate, and brain activity, helps some people with chronic headaches. It may be coupled with relaxation therapy, which teaches other stress-reduction methods. Studies have shown that biofeedback relieves migraines about as effectively as migraine medications, and that the two treatments together may provide greater relief. A formal biofeedback session usually lasts a half an hour to an hour, and should be repeated over the course of weeks or months. Often, WellStar psychologists incorporate elements of biofeedback into evaluations and other forms of psychotherapy.
  • Thermal Biofeedback is training to raise hand temperature consciously. Patients are not told how to raise their hand temperatures, but are instructed to imagine that their hands feel warm; their actual hand temperature is displayed on a monitor. Those who succeed sometimes experience a decrease in occurrence and severity of headaches.
  • Similarly, electromyographic (EMG) training provides a direct measurement of muscle tension in the face, neck, and shoulders, to teach patients to control this tension and reduce their headaches.

Case Example: A recently-divorced woman with chronic migraines learns to track the onset and intensity of her headaches, as well as her daily stress level. After two sessions, she has identified a relationship between her stress and her headaches. By session four, she has learned to decrease her migraine occurrence and intensity by implementing new coping strategies and incorporating thermal biofeedback techniques into her symptom management.

Managing Sleep Problems

Insomnia is difficulty falling or staying asleep that impairs daytime functioning. In a 2002 poll, 35 percent of adults in America reported nightly insomnia, and 58 percent said they had insomnia at least a few nights per week.

The most common treatments for insomnia are pharmacological. There are dozens of over-the-counter and sleep aids, and they do often work, at least in the short term. However, the long-term use of such drugs entails adverse effects like habituation and dependence, reduced motor and cognitive performance while awake, and sleep disturbance.

Fortunately, insomnia is usually quite responsive to psychological treatments; research has demonstrated that behavioral and cognitive-behavioral psychological interventions are just as or more effective than medications at reducing insomnia over the long haul.

The standard course of insomnia therapy generally entails six to eight weekly sessions to unlearn behaviors that prevent sound, restful sleep. These sessions may include:

  • Sleep education – regular sleep schedules, and controlling napping, exercise, nicotine, caffeine, and alcohol.
  • Cognitive therapy – addressing unrealistic expectations about sleep and the effects of insomnia.
  • Stimulus control – reducing anxiety about sleeping. If you can't fall asleep, get up and do something.
  • Sleep restriction – curtailing the amount of sleep, causing fatigue and easier and deeper sleep.
  • Relaxation – muscle relaxation and breathing techniques that simulate the onset of sleep.