Pain Management Psychotherapy, A Practical Guide

American Journal of Clinical Hypnosis,  Apr 2003  by Torem, Moshe S

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Pain Management Psychotherapy, A Practical Guide. Bruce N. Eimer & Arthur Freeman. New York, NY: John Wiley & Sons, Inc. (1998). xi +517 pages, $110.00. Reveiewed by Moshe S. Torem, M.D., Akron, OH.

In their preface (page vi), the authors define pain management psychotherapy (PMP) as "the clinical application of behavioral and psychological methods, in a professional context, for alleviating emotional suffering, improving pain relief, and promoting pain management". They promote a model of pain management psychotherapy which utilizes a hypno-cognitive behavioral approach, and emphasize that their model is not a substitute for adequate medical evaluation, treatment and follow-up care. The book is intended to address the behavioral, emotional, cognitive, and interpersonal aspects of pain problems with the goal of reducing emotional distress and the suffering associated with pain.

The book begins with a 28 page introduction, titled "The Medical Necessity of Psychotherapy for Pain Management". This chapter begins with the statement of several facts emphasizing the enormous medical, social, and economic costs of pain in lost work days, disability, compensation, and medical and surgical treatments. The chapter gradually leads the reader to understand that even though proper and competent medical diagnosis and management of patients with pain are essential, there are many indications for the use of pain management psychotherapy techniques including those involving hypnosis. The authors make a special effort to define the difference between acute pain and chronic pain, delineating the evolution of the concept of a chronic pain syndrome. They lead the reader into seeing the relevance of effective PMP by listing a variety of techniques such as structured psycho-educational teaching, cognitive therapy, self-monitoring, teaching new coping skills, psycho-physiological self-- regulation, hypnotherapy and imagery work and cognitive emotive reprocessing of traumatic memories associated with pain. What would make this chapter more complete is a brief review on the phenomenon of pain and the placebo, referring to the extensive work on the subject by Shapiro and Shapiro (1997).

The remainder of the book is organized in three different parts. Part I is focused on pain assessment and treatment planning and is comprised of three chapters which cover the evaluation of pain intensity, beliefs, and coping strategies, and case and treatment conceptualization. Part II of the book is comprised of four chapters and is titled "Cognitive, Behavioral Pain Management". This second part of the book is devoted to the explanation and review of the essence of the cognitive behavioral model and its utilization in pain management psychotherapy. Skills such as self monitoring, cognitive restructuring, stress inoculation training, uses of EMDR with chronic pain, and help with sleep problems, anger, de-conditioning, avoidance, and deficits in self-- assertiveness, are featured. The chapters are rich with numerous references from the literature as well as specific case examples to illustrate certain points.

Part Three of the book introduces the reader to the concept of the Hypno-- Behavioral model and how to use it in pain management psychotherapy. This section includes a variety of hypnotic and imagery based strategies in the treatment of patients with chronic pain, the formal assessment of hypnotic capacity and hypnotic responsiveness as well as detailed examples of hypnotic induction strategies and the nuts and bolts of strategic uses of hypnosis for pain control. In this section the authors go into details introducing therapeutic pain relief imagery. The authors delineate numerous types of pain relief imagery, such as symptom alteration imagery, attentional diversion imagery, "healing lights" and "neutralizing spirals" of energy-imagery, technology metaphor imagery, nature type imagery, inner advisor imagery, and "time travel" imagery.

All in all, this book is very well organized and is encyclopedic in nature. It is an excellent introduction to the therapy novice who wants to learn how to assess and utilize psychotherapeutic and cognitive-hypnotic based techniques in the treatment of patients with chronic pain syndromes. It is rich with references as well as "how to" techniques in the assessment of new patients, such as how to listen effectively, assess the symptoms of pain, and offers many examples of how to write a detailed letter or report to the referring physician after the psychologist has completed the assessment. The strength of the book is in its organizational flow, and the detailed description of techniques and how to utilize them in the practice of psychotherapy with chronic pain patients. Another strength of the book is its detailed inclusion of numerous questionnaires and assessment scales in the appendices.

However, this book could have been more complete had the authors reviewed the seminal work of WS. Kroger and WD. Fezler (1976) regarding the hypno-behavioral treatment model as well as its origins and rationale. The book might have also been strengthened by the inclusion of ego strengthening techniques (1999) as well as Ego State Therapy (1997) in the psychotherapy for patients with chronic pain. All in all, Pain Management Psychotherapy is an excellent contribution and addition to the literature, integrating hypnosis with cognitive behavioral therapy in the psychotherapy of patients with chronic pain.