123-Chronic Pain in Older Adults: 4 Psychological Themes Every Therapist Should Know - Podcast
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Jennifer Steiner, PhD, ABPP: [00:00:00] a survey done by the CDC back in 2016, found that 28.4% of adults in the United States were living with chronic or high impact chronic pain and adults over 65, were actually about 60% of that group. So it's truly a lot more people than we, we tend to think about

Regina Koepp: Today we're talking about chronic pain and the impact of chronic pain on mental health. Today's guest expert is Dr. Jennifer Steiner. Dr. Steiner is a board certified clinical health psychologist and founder of Beyond the Body Health Psychology Services.

It's a private practice in Atlanta that focuses on chronic pain and illness. She also serves as co-director of the Center for Mental Health and Aging's Continuing Education Program and as adjunct professor at Emory School of Medicine. Part of her service includes being a board member of the Georgia Psychological [00:01:00] Association Board of Directors, and in a couple of other capacities with the Georgia Psychological Association.

Dr. Steiner is an expert in the field of pain psychology. She has worked with patients with chronic pain for over 10 years and has published multiple scholarly articles on psychological correlates and interventions for chronic pain. I'm delighted that Dr. Steiner is here imparting her knowledge to all of us for and working with a population that is larger than you might imagine.

So thank you so much for being here, Dr. Steiner.

Jennifer Steiner, PhD, ABPP: Absolutely. I'm happy to be here. And it's funny that you mentioned that the population is larger than one might think because it really is quite a significant proportion of the American population. The most recent study that really looked at this was a survey done by the CDC back in 2016, which found that 28.4% of adults in the United States were living with chronic or high [00:02:00] impact chronic pain and adults over 65, were actually about 60% of that group. So it's truly a lot more people than we, we tend to think about

Regina Koepp: what sort of pain conditions are the most common. I.

Jennifer Steiner, PhD, ABPP: So for older adults, the most common tend to be osteoarthritis, chronic low back pain, and diseases that tend to be associated with degradation of the joints.

I would say in terms of the general population, idiopathic chronic low back pain is high up there, as well as fibromyalgia, rheumatoid arthritis and osteoarthritis as well.

Regina Koepp: That turns out to be like more than 50 million US adults are living with chronic pain.

Jennifer Steiner, PhD, ABPP: Yes. Yeah. It is an unbelievable number of people and there's good reason why we were talking about it as an, a chronic pain epidemic because it is, but it's gotten overshadowed

Regina Koepp: So as a psychologist, we have lots of different [00:03:00] avenues to specialize in or choose from. What inspired you to specialize in pain and health psychology?

Jennifer Steiner, PhD, ABPP: Wow that's a good question. So in all honesty, I grew up in a family with a lot of chronic pain a lot of chronic illness and myself included I grew up with a chronic pain condition and I, watched how I dealt with it and I watched how my family members dealt with it and we all handled it a little bit differently.

But the one common theme was that there really wasn't enough support for what we were all trying to get through in our own way. And there weren't therapists or doctors or anybody really who could really speak to how it affects the whole person. And I thought somebody's gotta do this work.

And that's the short version of how I got here

I think that's what keeps me invested in this work is I just feel very passionate about helping people learn to live better with this. Cause it can really have a very negative impact, but it doesn't have to.

Regina Koepp: What sort of negative impacts have you seen as a psychologist and [00:04:00] also know from firsthand experience?

Jennifer Steiner, PhD, ABPP: There's this common misconception with physical pain that pain only impacts the physical body and the reality is it, that is just not true.

I think partly people kind of default to thinking that way because not everybody experiences chronic pain or they're not familiar with it. And so we tend to think of it from more of an acute or short term model because that's what we're used to. So oftentimes I think the best way to approach it is to actually think about it from your own experience and imagine a day that you've had a really bad headache or a bad head cold or something.

Something that's definitely unpleasant but not long term. And for most people, those types of experiences can interfere with your day or your week. You might have pain that gets in the way of, concentrating at work or how well you sleep or just taking care of things around the house.

It tends to go away after a couple of days, and then you're back to life as usual. But for people with chronic pain, which by definition is pain that's been present for six months or more almost every day, [00:05:00] those experiences become part of everyday life. And so when those type of interferences start to become the day in, day out, it can then lead to a lot of other challenges.

For example. Just the ability to maintain employment. So if pain is getting in the way of you being able to perform at work or even to show up to work, that could be a really big issue. And that in turn can affect your finances or the ability to provide for one's family or oneself.

And when that starts to happen, in some cases people might notice a change in how they think about themselves because if they were defining themselves by their work or their ability to provide for the family, that can really change or shift one's kind of self-concept. And all of that can cause a lot of tension in relationships as well.

And it's not uncommon for some of those changes to lead to depression or anxiety or stress. And then all of those experiences really start to feed one another. It gets really messy, really quick. So those are some of the ways that I've seen it happen, but I also think it's important to know that's, when I'm talking about, it's not just [00:06:00] based on my clinical experience or even my personal experience, though it definitely rings true.

The research supports this as well. There's been some research done by Crowe and colleagues in 2017, and they looked at 40 or 41, I believe, studies that were looking at the experience of chronic pain. And in doing so, they were able to come across or determined themes.

And one of them was this idea of the body as an obstacle. So the body and the physical experience of pain getting in the way of life, getting in the way of doing the things that people want to be doing that make life meaningful. What we were just discussing. I think the most concrete. Example would be like if you wanna walk to the mailbox and all of a sudden pain, the physical experience of pain is getting in the way of you getting to the mailbox to get to your mail.

It's, the physical experience of not being able to do something you wanna do.

And the second theme they came across that I think is really important to mention is this idea of pain being invisible, [00:07:00] but also pain being real.

And this is just a huge important thing to touch on because, pain, we can't see it, unless somebody has some kind of an assistive device, like a Walker or a rollator or something, or they're engaging in some kind of pain behavior. Like they might be rubbing a joint or limping or a facial display of pain, like a grimace, something to show you, to cue you in, Hey, there's pain here.

We don't see it. And as humans we don't really do a great job with things we can't see or touch or measure. And that's the other issue with pain is that right now we don't have a good objective, measurable way to determine how much pain somebody is in. Right now it's largely subjective.

And I will say science has come a long way, medical science, and we're a lot closer to coming up with some objective pain measures than we were, even just 10 years ago. But we're not quite there yet. And so when we ask somebody what they're experiencing when it comes to pain, we're reliant on their ability to describe it to us and on [00:08:00] their experience and their report of that experience.

And pain is very unique to the individual. And so I think the fact that, A, we can't see it and b, we don't have a good way to measure it, makes it much more easy to stigmatize. And so people with chronic pain are often experiencing the sense that they're not being believed. And that can lead to a lot of frustration and also contribute to depression.

So that was something we see a lot, but it was also a theme in this particular study.

The third one was this idea of a disrupted sense of self, which I talked about a little bit already. Just when pain comes in and takes away some of the things that kind of make you, you. It can leave a person feeling like, okay, where do I go from here?

Who am I right now? It's not uncommon to hear people talk about that was the me before pain, or That was my life before this particular illness. This is the me now is almost like two completely separate people. And that's a real kind of adjustment for individuals.

The fourth theme was this [00:09:00] idea of an unpredictability of the condition.

So with chronic pain, you often hear people talk about good days and bad days. And the fact that you don't always necessarily know which day gonna be a good day or bad day, you it's very common for people to feel good and be able to go out with their friends or take care of all of their things around the house and really feel like they're getting quite a lot done.

And then the next day be stuck in on the couch or in bed trying to recover and it can feel really unpredictable. And while I have found that with some guidance, a lot of times people with chronic pain can identify their triggers and figure out which days are gonna be up and down and whatnot.

That doesn't mean their loved ones or the people that they're around day to day can figure out that rollercoaster. And so that unpredictability tends to lead to more challenges with interpersonal relationships and fulfilling commitments and again, contributes to that stigma. And so those are just, some of the ways in which chronic pain really can grow fingers, if you will, and really start to get into all the [00:10:00] aspects of somebody's life.

And so to me, it's really not surprising that it would have a big impact on mental health.

Regina Koepp: So the themes were one body as an obstacle, two, pain is invisible and it's real. The third theme was a disrupted sense of self. And the fourth was unpredictability. And you gave some great examples about how that influences relationships.

And I really appreciated also the commitments, like the unpredictability of what, where will my pain be and can I manage my commitments on those days?

Jennifer Steiner, PhD, ABPP: Can you make a plan when you don't know how that

pain is going to be on any given day? And that's something a lot of people struggle with.

Regina Koepp: You brought up an important concept of stigma related to living with chronic pain. Can you talk a little bit more about the stigma that people living with pain experience?

Jennifer Steiner, PhD, ABPP: Part of it goes back to what we were just talking about in terms of the unpredictability and the fact that we can't see it.

And so a lot of times because [00:11:00] of those factors loved ones or people that you would associate with may have thoughts like you were fine yesterday. Why can't you do that today? Or, but you don't look sick. That's the one I hear all the time is, but you don't look sick or you don't look like you're in pain.

And I think a lot of times that gets internalized by people who have chronic pain is they think it's all in my head or they think I'm faking or they think I'm lazy or that I'm making it up. And sometimes those messages directly are what is being told to the person who's living with pain. And when you know that's just not the case, that really can be devastating to relationships and people tend to then pull away, if you're getting these messages from people that they don't believe what you're going through, why would you associate with these people? Why would you put yourself in that situation?

And so you tend to become increasingly isolated as a result of some of that stigma. And honestly, it happens in doctor's appointments sometimes too. I would love to believe that it's happening less with [00:12:00] better education, but it still happens. There are still medical providers who are not super well, well-informed about these topics and, brush it off.

And some of that's based on, biases and some of it's just based on not being well-informed, but there's a lot of stigma there.