November 10-15

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ACR Convergence 2023

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Behavioral therapies can help with chronic pain


3 minutes

An ARHP clinical symposium this afternoon will provide insight into the use of fun behavioral strategies that patients can use to manage pain related to chronic conditions such as fibromyalgia, lupus, and lower back pain.

Afton Hassett, PsyD

Practitioners can assist patients by helping them improve their emotional well-being, said Afton Hassett, PsyD, a licensed clinical psychologist and an Associate Research Scientist in the Department of Anesthesiology at the University of Michigan.

Something as simple as having patients keep a gratitude journal can help, said Dr. Hassett, one of the speakers in this afternoon’s Resilience: Functional and Neurobiological Influences. One way to keep a gratitude journal is to have the patient write down three things every day for which they are grateful, she said.

The challenge is that every day must include different things or experiences. At the core of a positive activity such as this, Dr. Hassett said, is encouraging someone to search for the good in one’s day and life instead of focusing on the bad.

Other strategies include having the patient pause at the end of the day to recount things that made them happy or simply encouraging them to schedule something fun into their day with the same level of commitment as going to work or attending a doctor’s appointment.

“What happens when people have chronic illnesses is they tend to give up all their valued life activities in favor of just doing the stuff they have to do to survive — get the kids to soccer, get to work, get to the dry cleaners, make dinner,” Hassett said.

Many health care professionals can prescribe positive activity interventions because they don’t require specialized training like other psychological interventions that require a trained mental health professional, she said. Patients who do this tend be more active, sleep better, and are more likely to have uplifting social relationships with friends and family.

Tor Wager, PhD

Co-presenter Tor Wager, PhD, Director of the Cognitive and Affective Control Laboratory and Professor of Psychology and Neuroscience at the University of Colorado in Boulder, will outline strides in developing brain markers that help establish the level of acute clinical pain that a patient is experiencing. Dr. Wager would like attendees to leave with a more nuanced view of brain imaging and the understanding that clinicians need to dig deeper for answers if they find enhanced brain activity.

His research has found that a brain scan can gauge pain intensity by tracking relative blood flow across many areas.

“There is a particular signature that responds when you are feeling more and more intense physical pain, and so we can measure the intensity of the response in that pattern,” Dr. Wager said.

A key focus of the research is differentiating between physical pain and the emotional pain caused by bad experiences such as being rejected or watching other people in pain. Rather than there being a common pain affect system in the brain that responds generally to badness, as some science argues, his research has found there are different brain patterns that differentiate, for instance, between pain and rejection.

“We are starting to be able to draw boundaries between these different concepts at the brain level, and the brain seems to really respect those boundaries,” he said.

Making that distinction, Dr. Wager said, can influence the course of actions.

His lab found that pain signals really are enhanced in patients with fibromyalgia. His research has also discovered that fibromyalgia is associated with more than just pain. It also causes negative responses to basic sounds and basic visual stimuli.