SOURCE:  The below document is an extract from The Interstitial Association Newsletter (USA  Professional Perspectives Fall 2008) Pages 5 -7

Easing the suffering component of pain was the common denominator of nearly all the adjunctive therapies discussed here. That, of course, must be in addition to easing its physical component, not instead of it. For IC patients, cognitive behavioral therapy (CBT) has been the most-discussed nonmedical adjunctive therapy. As psychologist and behavioral medicine specialist Geralyn

Datz, PhD, noted, this kind of therapy is not about changing pain scores but about increasing patients’ ability to deal with the pain that they have. Indeed, an NIH assessment found CBT to be only moderately successful for chronic pain. The goal of CBT in pain management, she said, is to alter patients’ belief that pain is unmanageable, educate them to become resourceful problem solvers instead of helpless and hopeless, help them learn to monitor pain sensations and their emotional and behavioral responses to it, develop techniques to cope better with pain and emotional distress, and develop strategies to cope after treatment ends.
If you aren’t a psychologist, you can still do some assessment and use some techniques to help patients. The patient pain profile (P3) is a brief, 44-item measure that assesses anxiety, depression, and “somatization” (available at www.pearsonassessments.com). You can use this as a teaching tool with your patients or even just explain the gate control theory of pain to help patients understand how psychological factors can affect their experience of pain. And a referral for even brief psychotherapy, she said, can be very helpful. Individual therapy is usually designed to be short term, from 8 to 16 sessions that are very present oriented and problem focused.

She pointed out that your patient isn’t always the only one who needs to modify attitudes about pain. The family may need to as well. It’s a big problem when patients’ families believe patients are addicts, have pain because they aren’t working hard enough for their recovery, have pain because they aren’t spiritual enough—attitudes that are common. As your IC patients’ primary medical provider, you may help affect those beliefs by talking to the family members about the nature of IC pain, said Dr. Datz, who is Director of the Pain Management Program at Forrest General Hospital in Hattiesburg, Missouri.
“Taking the suffering out of a painful condition,” was indeed how hypnosis practitioners and instructors Daniel Cleary and Michael Ellner described the goal of medical hypnosis in pain management. An NIH expert panel called evidence of its effectiveness “strong” in chronic pain from cancer. The panel also said the literature suggested effectiveness in other chronic pain conditions such as irritable bowel syndrome and temporomandibular disorders, conditions sometimes associated with IC.

Many think of hypnosis as trance, but it includes other techniques, such as direct and indirect suggestion, that you can easily incorporate into your practice, said Ellner and Cleary. For example, because hypnosis is about changing perception, just the language that you use with patients can be “hypnotic” and alter that perception. For example, asking your patient to describe “that pain there” is a technique of dissociation, making the pain an object and helping the patient dissociate emotions from it. Other techniques, such as imagining the pain as a different size, can help change patients’ perception of the discomfort.
While Cleary and Ellner demonstrated the potential of providers’ positive suggestions with the language of success, such as “I can help,” they also urged providers to get away from negative suggestions they may not realize are “hypnotic” and can undermine progress. Examples of those included, “You have to live with it,” which they likened to a life sentence, or “It’s all in your head,” which shatters rapport, promotes depressive feelings, and increases pain and dysfunction.

Meditation, imagery, and deep relaxation are also hypnotic techniques, Cleary and Ellner explained. In IC, these are being researched and used with some success by Ragi Doggweiler, MD, at the University of Tennessee, Knoxville, and Ken Peters, MD, and the team at William Beaumont Hospital in Royal Oak, Michigan. You can encourage your patients to use guided imagery and relaxation recordings, and you can perform simple guided-imagery exercises with them that take only a couple minutes and help reduce pain (see box below).
Too “out there” for you or some of your patients? Try tickling their funny bone instead, urged Hob Osterlund, APRN, from the Department of Pain and Palliative Care at the Queen’s Medical Center in Honolulu, Hawaii.

She is also President and Producer at Health, Humor & Hospitals, Inc, which produces the Chuckle Channel for inhospital broadcasting, and she performs healthcare standup as her alter ego, nurse Ivy Push.
But seriously, humor is becoming evidence-based medicine, just as hypnosis and other mind-body techniques are. Indeed, the effects may be just as good. Osterlund pointed to a randomized controlled trial that found humor increased pain thresholds just as much as relaxation did. Research has demonstrated significant humor-induced increases in endorphins, growth hormone, NK cell activity, and immunoglobulins G, A, and M. A number of other studies have shown increases in pain thresholds with humor treatment.
Osterlund is a principal investigator for the COMIC (comedy in chemotherapy) Study at the Queen’s Medical Center, a randomized, controlled trial looking at comedy’s impact on stress, the immune system, and cancer symptoms in chemotherapy patients. Preliminary results showed significant positive effects of humor videos on pain, appetite, tiredness, depression, and general well-being. The effects are also being assessed on symptoms and levels of salivary IgA and cortisol.
Advise patients to put humor in their life and even make them laugh yourself, as long you keep the humor gentle, inclusive, and appropriate, said Osterlund. After all, the bladder gives IC clinicians a golden opportunity to make their patients smile.