Karen Hoving, Ph.D. 


Chronic Pain

Many people are struggling with chronic pain and they seem to only consider going to their GP or Specialist for medication. Often, when you go to your GP the one thing you don’t admit to is how your physical pain is effecting you emotionally.

I have struggled with Systemic Lupus and Rheumatoid Arthritis for about 20 years. Even as a Psychotherapist I hid my depression about the days that the pain was so bad I couldn’t take care of my children or get out of bed. I spent years afraid to discuss pain medication for fear that my doctors would think I was “medication seeking.” Ultimately, being unable to feel free to speak to some one caused me to isolate I assumed most of my friends were getting bored with hearing about how I couldn’t commit to meeting with them because it all depended on how I felt that day.

When I was first diagnosed there weren’t many therapists that worked in the field of helping people with chronic illnesses. Many assisted with people dealing with death and dying issues but what about those of us who WEREN’T going to die, but on many days wished they would. Now, I don’t mean that people with chronic pain are actively suicidal, but there are many people who wake up at 2 am and are in so much pain they just want it to stop. Their quality of life has decreased, and they don’t have the energy to attend support groups. I remember doing a project for Proctor and Gamble in the 1990’s and as part of the project I had to investigate online support groups. So I decided I might as well get some use out of this so I looked up support groups on AOL ( the main server at the time) that focused on Lupus, RA, and Fibromyalgia. It was amazing, I was sitting on my bed, wrapped in multiple heating pads, and finally “met” a lot of women who were dealing with what I was. The first time I went on I remember the tears streaming down my face because I could finally be honest about so many issues that I had minimized to my doctor, my friends, and mostly to myself. But even with a Ph.D. in Psychology it never occurred to me to find a therapist. I guess part of my issue was feeling humiliated that at that time I was so sick I had to take a sabbatical away from my career. Which was devastating $80,000 worth of education and I was spending months in hospitals, at home in bed in my 30’s dealing with joint replacements, extreme pain, and having a hard time taking care of a toddler.

What I found in this group were like-minded people who understood, didn’t judge, and helped me to find the laughter that I had lost. Unfortunately, after a year I ended up leaving AOL and haven’t managed to find a group that was similar. However, it did give me the courage to  become more open with my Rheumatologist about wanting to return to work, and that meant finding medications that were going to help with the pain but not make me loopy. And once I explained this she came up with some brilliant ideas. But I have to admit, I had heard so many stories of women telling their “rheumies” about pain and being told to take Tylenol that I was terrified when I finally took the plunge and told her I couldn’t handle the pain any more. Granted, this was in 2003, so I had struggled with severe and chronic pain since 1995. So it wasn’t like I had one swollen joint and ran in screaming for narcotics…but in my mind, that’s how it felt! All this education and it honestly came down to “physician HEAL THYSELF!” Or at least be HONEST with thyself!

I now work with women that are depressed – and often when they finally call me they mention, almost as an aside, that they too struggle with Lupus, RA, Fibromyalgia, MS and other chronic illnesses that are making them sad, angry, depressed and dealing with spouses and children that think they are faking it. Granted, many connect with me specifically because I am open about having the diseases I have. I teach them about how to find doctors that care, will listen, and won’t assume they are drug seeking whiners. I was lucky, I have an amazing doctor that immediately “got me” – well that and she had at the time I walked into her office, 8 years of surgeries, pain, strokes, blood clots, and hospitalizations to back up why I was in pain. I also had an extensive family history of SLE and RA. So I was diagnosed quickly ( the average time it takes to be diagnosed with SLE is about 5 years but I was diagnosed almost immediately because I had so many family members with it my GP who made the original diagnosis immediately).

As I look back, I wish I had found a therapist to talk to. I adored the online groups but you do need to share your time, and support others. And there are some days where things are so bad you just don’t have it in you to listen to others .I know that sounds selfish, but that is why I encourage new callers to come in if they are dealing with chronic pain. We don’t only just talk about them, but I get them trying meditation- which I usually get a lot of push back on initially. I mean why would mindfulness/meditation help when narcotics won’t.It takes too much time. I was busy this week…I’ll try next week.

Well, when I discovered mindfulness I found that the hype was true. It does help with depression and physical pain. Now is it methadone? No. But it made a huge difference in my pain threshold, and my feelings about life. Meditation helps me feel better physically so I can give back to my patients. I only wish I had been told about it when I was lying in bed watching movies and feeling like going to Graduate School had been some divine cruel joke by a mean higher power that wanted to show me what I could attain and then snatched it away.

No matter what kind of pain you are struggling with: back pain from an injury, a rheumatological or autoimmune disease, when you find yourself isolating, hiding and avoiding – take a chance. First ask your specialist for the name of a Psychologist or Psychotherapist  that works with people with chronic illness. If you are really in the pits, talk to your doctor about some of the medications that help with depression and pain (Cymbalta is a popular drug with my patients- but it isn’t right for everyone – um that is my way of popping a disclaimer in!). And DON’T MINIMIZE YOUR PAIN! I know it’s fashionable to be tough but enough is enough! You are not weak, you are dealing with diseases that are attacking your nerves, joints, body! If your doctor knows you well, you can be honest. If S/He blows you off it’s time to consider seeing a pain specialist (many doctors are scared about getting patients “hooked” on pain medication. Which is sad because research shows that if you take pain meds when you are in pain, and not as a ” oh I’m feeling bummed today, I’ll pop a few percocet’s” you don’t get addicted.) Sadly , because of the abuse of pain medication doctors are terrified of losing their licenses. But if you have a legitimate issue, find a specialist that understands and will help you.Pain specialists are typically anesthesiologists and they know real pain from fake it pain. They often come up with some amazing ideas and they aren’t afraid of loosing their licenses, so that takes the pressure off your regular doctor who is still handing you NSAID’s to help with off the chart pain.

And look into swimming in warm pools (your insurance will pay- but you’ll need a referral from your specialist), meditation, tai chi, whatever floats your boat. Western medication isn’t the only way- there are many studies on changes in the brain when you meditate that help with severe pain.Also seeing a therapist can give yourself an hour a week to JUST TALK ABOUT YOU! Not having to give feedback to others when you are in too much pain, emotionally and physically. That doesn’t mean you are selfish- we all have those days. I know with illnesses money is a factor, but many therapists (myself included) offer sliding scales .And see if they will meet you online for days when you are in too much pain to drive to their office. I regularly meet with patients on Skype or Facetime for sessions when their pain is too high to drive to my office. Many therapists offer this option. I have done hypnosis and meditation training online, as well as listen to people’s experiences. The only thing I haven’t been able to accomplish is extensive art therapy (unless the patient is willing to snag some of their kids crayons and paper) and Sand Tray Work. But, with luck, as our work progresses and they feel better they find they can come into the office to do special sessions.

Every day is a challenge. But there is hope. I was convinced I’d never work, but by facing my demons, getting a great medical support team, and being honest about my struggles I’m back working and hopefully giving back to individuals that have walked the walk that sometimes I need to crawl.Namaste.

ABOUT THE AUTHOR: Dr Karen Hoving has a Ph.D. in Clinical Psychology. She specializes in Depression, Anxiety, Post Traumatic Stress Disorder (PTSD) with predominately women. She works south of Denver in Aurora, CO and has been in practice since 1990. In the 1980’s she had a full time Hypnotherapy Practice in Ohio.



One Response to Psychotherapy for Chronic Pain

  1. You are a brave woman. I only skimmed this article, but your strength is remarkable. It made me cry. I can identify. God bless you and all the work you do for others.

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