Integrated Pain Mental Health Services at the Medical College of Wisconsin

The Integrative Mental Health approach begins with an intake. This initial intake serves an avenue for development of an individualized treatment plan. Patients will complete this intake in CHOIR (Collaborative Health Outcomes Information Registry) related to function, mood, pain, anxiety and sleep which will be tracked to evaluate progress.

For patients seeking an implantable device or other surgical or procedural intervention, we provide the necessary evaluation for approval and offer strategies to increase chances for a successful outcome

We offer individual and group psychotherapy using a cognitive behavior approach aimed at assisting patients to cope with their pain and life stresses. Therapy may include the following empirically proven treatments: cognitive behavior therapy and biofeedback, mindfulness based approaches and guided imagery. Forms of cognitive therapy frequently used include: acceptance and commitment therapy (ACT), behavioral activation (BA) and motivational interviewing.

Most therapy is scheduled for 45 minutes and is generally goal oriented.

Biofeedback is a technique used to learn to control body functions, such as heart rate. In biofeedback, the patient is connected to electrical sensors that help to receive information (feedback) about the body (bio). This feedback helps focus on making subtle changes in the body, such as relaxing certain muscles, to achieve the results you want, such as reducing pain.

Essentially, biofeedback gives one the power to use thoughts to exert control in the body. Heart rate variability biofeedback, galvanic skin response (GSR) and thermal biofeedback modalities are often used. Biofeedback is often used as a relaxation technique with pain patients.

Mindfulness refers to a state of active, open attention on the present. Copious research exists regarding the benefits of mindfulness based therapies for chronic diseases and pain conditions. 

Meditation is a practice in which an individual trains the mind to realize some benefit such as less stress, less pain, greater sense of control.

Guided imagery is a gentle mind-body therapy using the imagination and visualization particularly applicable for pain patients.

The Academy for Guided Imagery (AGI) classifies the therapeutic application of guided imagery into three categories:

• Stress reduction and relaxation
• Active visualization or directed imagery - for improving performance, changing behavior, or influencing an outcome
• Receptive imagery - in which words and images are brought to consciousness to explore and give information about symptoms, treatments, moods or illnesses

Through supportive strategies such as groups and family or caregiver involvement patients and families can be education on effective techniques for living well with a pain condition.

Research into effective strategies for managing pain which involve the mind-body system is one of our goals. Subject accrual is completed in our heart rate variability biofeedback study and preliminary data analysis are promising.

Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that lead to less productive actions and the beliefs that direct these thoughts, people can modify their patterns of thinking to improve coping. Cognitive behavior therapy is not the same as the more traditional psychodynamic psychotherapy in that the therapist and the patient will actively work together to help the patient recover. Patients in CBT can expect their therapist to be problem-focused, and goal-directed in addressing their symptoms. Since CBT is an active intervention, one can also expect to do homework or practice outside of sessions. There is extensive research to suggest the benefits of CBT for treating pain conditions.