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.
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:
- Quick Start for Pain self-management classes (2 sessions) held at Pan Am Clinic.
- Pain Tools for Life: Pain Management Program held at Health Sciences Centre.
- Psychological evaluation to determine appropriateness of a behavioral treatment approach for chronic pain.
- Pre-surgical assessment for surgically-implanted pain-modifying devices.
- Behavioural pain management groups based on a mindfulness-based cognitive therapy (MBCT) or acceptance and commitment therapy (ACT) approach. The groups are facilitated by one or two psychologists and typical enrollment is 8 to 10 individuals.
- Individual therapy may be offered emphasizing the development of pain-coping or mindfulness and 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 Clinics can be referred directly to the Clinical Health Psychology Program.
Description of services and treatment
Cognitive-behavioural therapy (CBT) and acceptance and commitment therapy (ACT) 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, identifying pain triggers, identifying unhelpful thinking patterns, improving pain communication skills, and relaxation training. These types of strategies are presented at the Quick Start and the Pain Tools for Life sessions.
Mindfulness-based approaches encourage paying attention to the present moment in a curious, non-judgmental, and self-compassionate way. By becoming more mindful, a person is in a better position to change their relationship with their present experience, from one of antagonism, to one of acceptance. In this way, more resources can be devoted to self-care and engaging in nurturing activities, as part of both pain management and overall well-being.
ACT interventions are primarily experiential and much of this experiential learning occurs by contacting and relating to metaphors, through various forms of mindfulness meditation, and by following through on valued intentions. 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. ACT 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.
Dr. Brigitte Sabourin, PhD, C. Psych. (Health Sciences Centre)
Dr. Gregg Tkachuk, PhD, C. Psych. (Pan Am Pain Clinic)
Health Sciences Centre Pain Management Centre
Clinical Health Psychology Program, Health Sciences Centre
Phone: 204-787-7424 (CHP General Office)
Pan Am Pain Clinic
Quick Start for Pain Self-Management Classes (2 sessions): offered several times per year.
Pain Tools for Life Program: offered every Tuesday 1:00-3:00 pm, except July and August.
Behavioral Pain Management Groups (8 sessions): offered several times per year, usually starting in January, April and September.
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/
Links 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: