October 2018

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Dr. David Williams on Managing Chronic Pain

Excerpts from our conversation with Dr. Williams, associate director of the Chronic Pain and Fatigue Research Center at the University of Michigan

NIHNiH: Your team does research into using types of talk therapy to help people manage chronic pain. How do people tend to feel when a psychological therapy is suggested for their pain?

Williams: People have grown up in a world where when you get sick, you go to the doctor and they give you a pill to feel better. That’s what people are used to. But chronic pain doesn’t necessarily respond to that model and isn’t necessarily a problem in the location that hurts. Pain is processed in the brain even though it may be felt somewhere else in the body. Treatment of chronic pain needs to take into account how the brain processes pain.

A decade ago, many people with pain were very resistant to the idea of cognitive behavioral therapy or seeing a psychologist for pain. We’d hear “I have real pain, I want real medicine.” The fact is, however, “talk therapy” is real medicine. It has effects on the neurotransmitters and areas of the brain that process pain. You don’t always need a pill to alter the perception of pain. The whole field of behavioral medicine is founded on the concept that changing how you think and behave can have real effects on one’s physiology.

NIHNiH: How can addressing what’s happening in the brain change pain management?

Williams: Sometimes we can stop pain by fixing bones and tissues but other times we need to treat pain by going to where it is produced: in the brain. Treatment of chronic pain often needs to focus more on altering the perception of pain than fixing some area of the body. Perceptions are made up of thoughts, emotions, memories, and reactions to current events and behaviors. Thus successful treatment of chronic pain needs to include these factors as well as understanding the underlying physiological anomaly if one exists.

NIHNiH: What are some other things that can help with chronic pain that don’t require taking a pill?

Williams: There’s lots of evidence behind aerobic exercise. It hits a lot of the targets that are associated with chronic pain, whether it’s mood or sleep or fatigue. Of course, people find it to be difficult to exercise even if you don’t have pain. But exercise doesn’t have to be strenuous things like going to the gym. Recently there have been studies supporting the use of movement therapies like yoga and simply expanding your regular lifestyle activities. What these things all have in common is a foundation of being healthy. If you have a good foundation of health, you’re going to be able to manage pain more effectively over time.