The problems men encounter with Psychological Therapy for CRPS and Chronic Pain

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In order to treat chronic pain effectively (in whatever form it appears, CRPS, Neuropathic Pain, Myofascial Pain, etc) it is fundamental that both its physical and psychological aspects are addressed in tandem.

For somebody suffering chronic pain, psychological therapy can help them to understand, process and manage the thoughts, emotions and behaviour that accompany their pain. In doing so, the intensity of their pain can be reduced and their ability to adapt to living with their pain can be improved. In fact, it has been demonstrated scientifically that psychological therapy really can alter the way the brain processes pain sensations.

It’s a man thing

However, a constant problem faced by clinicians treating men with chronic pain is their greater reluctance than women to engage in and (importantly) to embrace psychological therapy.

At the risk of making a sweeping generalisation, men deal less well with their emotions than women. Even in today’s less gender-polarised society, boys are raised less well able to articulate their emotions than girls. Remember – ‘boys don’t cry!’ It is perhaps then not surprising that many men struggle considerably when, probably for the first time in their life, they find themselves being asked to ‘open up’, sometimes (and often this is more intimidating) in a group-therapy situation.

Gareth

A classic example was my client, Gareth (not his real name); a very matter of fact, six foot five inch, former professional Rugby player, for whom I had been able to arrange funding to attend a four week, inpatient, multi-disciplinary rehabilitation programme at the Bath Centre for Pain Services. As might be expected, this programme includes a significant psychological therapy component.

During the morning break on the first day of the course, Gareth phoned me and in none too polite terms informed me that the course was going to be “a complete waste of time” as he was “surrounded by tree-huggers” who were “intent on breaking my mind!

Fortunately, I was able to persuade Gareth to stay on the course and, importantly, to at least try to embrace the treatment, whatever its nature. At the end of the programme he told me that he had found the first two weeks extremely difficult, to the extent that he had considered leaving the course. However, things had then started to fall into place such that in the end he was very pleased that he had stayed the distance, saying that he was “in a hugely better place.

Type of therapy/therapist

From experience with clients over many years, I have found that men seem to deal less well than women in a group therapy situation, particularly during those uncomfortable early sessions. That does improve as time goes on but of course, just like Gareth, it’s all about persuading people to stay the course and if people are going to drop out, that’s far more likely to happen early on.

Early drop out can also be a problem with Cognitive Behavioural Therapy (CBT) as not only does it take a number of sessions before any real benefit is felt, but often people actually feel worse following the first few sessions.

With one-to-one therapy (of whatever kind), the most common request from both men and women is for a specific gender of therapist. Interestingly, there seems little or no pattern to these requests; some people (of whatever gender) simply prefer to be treated by men and others by women.

Comfort is crucial

The crucial thing is to make the therapy experience, and particularly the initial sessions of therapy, as comfortable as possible for the individual. That means listening to them and helping to address any apprehension or fear they may have, as well as giving them at least some indication as to what to expect at the first session. Clearly, this is more a role for the treating therapist. However, for those in litigation, their representative should at least be able facilitate an initial question and answer session with the therapist.

It is also vitally important that those closest to them are advised what to expect. In persuading somebody to stay the course, nothing beats the close support of a partner and/or close family.

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