IFS for Chronic Pain
and Chronic Illness
Chronic Pain
In my life as a physician, Palliative Care has been my career. Palliative Care specialists focus on the suffering that comes from incurable disease; we see a lot of chronic pain (pain lasting more than 12 weeks). It took over 11 years of training to become a Palliative Care specialist. By the time I saw my first patient suffering from pain as a licensed specialist with diplomas fresh on my wall, it seemed so shortsighted that most of what was expected from me was to prescribe opioids.
This is how a large fraction of the American medical system deals with everyday pain; with opioids. The only two interventions that have shown in studies to benefit chronic pain in non-cancer patients are physical therapy and psychotherapy; yet doctors hardly encourage these. Studies on opioid therapy have failed to prove they help with everyday suffering and functional recovery in the long run, and this is further compounded by the unacceptably high risk of dependence, overdose and death; why do doctors keep on prescribing them so much?
This is a larger conversation, but I do believe at the center of this is our inability to dialogue with pain. Our own, and therefore our inability to guide our patients through theirs. Better to numb. Better to cut this appointment 45 minutes shorter and prescribe a drug.
I am very interested in working with clients suffering from chronic pain, and I believe a healing approach to everyday pain can be done with the following tools:
1) Seeing chronic pain as a phenomenon inside a dynamic internal system of the mind.
Pain is not a purely sensorial phenomenon. Neurologically speaking, once a pain signal enters the brain, it will elicit activation of emotional, reward and meaning-making areas of our consciousness as well. By tending to pain without acknowledging the complexity of these intracerebral interactions, modern medicine has clearly been inept in its treatment of everyday pain, and has further gifted us an epidemic of opioids.
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"Every time I feel pain a part of me shames me for it", or "another part fears that if I continue to complain I will push people away from me", or "another part becomes overwhelmed with the prospect of losing yet another day in pain". Each one of these parts inside you is reacting to pain, each of them is trying to help; yet often these good intended parts generate the opposite effect. By increasing emotional distress around pain, by telling a story that is catastrophic or shaming, they're actually clouding the intrapsychic environment, and as a consequence lowering pain threshold by increasing emotional distress, increasing muscular contraction and decreasing muscle and bone circulation; all of which worsen pain.
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Exploring how your pain interplays in your system with IFS can lead to significant mental decompression around pain as an experience, and a life with more tolerable symptoms.
2) Mindful prescribing of pain medications to help live with pain.
I do believe that certain pain syndromes can benefit from a pharmaceutical intervention -even an opioid if need be. But whenever I prescribe a medication for pain, I share three intentions with my patient:
- I want to help my patient dialogue with their pain -not numb it.
- I want to prescribe medications that are unlikely to cause dependency and therefore make my patient even more helpless against their pain in the long run.
- I want to prescribe the least amount of dose, and for the least time possible.
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Medications that I usually prescribe for chronic pain include but are not limited to:
- Low dose antidepressants
- Low dose gabapentinoids (Gabapentin, Pregabalin (Lyrica))
- Low dose Ketamine
- Low dose Methadone
- Low dose Buprenorphine
- Medical Marijuana (NYS residents)
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3) Decreasing reliance on short acting opioids:
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For the past 3 decades, a type of medical care called "pain management" -an inflated term for sure- has sprouted across the US. What it consists on -in most cases- is prescribing of Percocet or another formulation of Oxycodone (a short acting opioid) in repeated doses during the course of the day. That is literally ALL THAT THIS CONSISTS ON. A striking number of Americans live on this tablet for pain every 6, 4 or even 3 hours! We have been asking patients to compulsorily take an opioid 8 times a day, 240 times a month; and we've been calling that management.
Unequivocally two things are true about these patients; they continue to suffer, but now they are dependent on Oxycodone.
The problem with this "strategy" is that with each successive dose over the course of months -and even years- patient's dependency on Oxycodone grows; and as a consequence they begin to experience more and more intense "inter-dose pain"; the next dose has become a more and more urgent matter, and life without the next dose has become less and less imaginable. These patients suffer plenty. And what's worse, parts of them have learned to believe that Oxycodone is "the only thing that helps them".
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If you are one of these patients; and you are interested in decreasing your reliance on Oxycodone, I will be more than happy to help you. If your intention is to continue to take multiple doses of Oxycodone per day every day of your life; I cannot be complicit in a type of care that is not helping you in the long run, and further compounding your helplessness against pain.
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4) Physical rehabilitation:
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Depending on the source of your pain -yet this is true for most pain syndromes- physical therapy or initiation of a form of physical activity will be key in your recovery; and I will encourage you to do this every single time that I speak with you.
Chronic Illness
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Chronic illness is an overwhelming journey. Beyond the vicissitudes of modern medicine, endless list of diagnostic studies, and even more endless list of medications, navigating multiple medical conditions is a tremendously triggering phenomenon for the internal system of the mind. I am interested in exploring with my clients which parts of them activate in and around their illness experience, and how this might interplay in their disease management and outcomes. Offering a compassionate loving approach to the parts of us that are carrying fear, confusion, grief, sorrow and any other emotion triggered by illness, can allow clients to confront their disease outlook -regardless of its direction- with increased self reliability and peace.
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