When patients see clinical psychologist Bridgette Sum, many have high hopes that she will be able to eradicate their chronic pain.
She tells them, gently, that she is not there to do that. Her role is to shift their perspective on pain and help them find practical solutions to live with it.
“It’s very easy to sink into a sense of helplessness,” she said of chronic pain sufferers.
“We focus on helping patients regain a sense of control by shifting their attention to what they can manage.”
Ms Sum, who specialises in pain, is part of the team at the Singapore General Hospital’s Pain Management Centre.
She sees between four and eight patients a month, with more females than males, and a median age of 50.
Depending on their needs, most patients do four to six one-hour sessions. Many suffer from fibromyalgia, a chronic disorder that causes fatigue and pain throughout the body.
The pain for most patients prevents them from functioning the way they used to. Some also have depression or anxiety, while others find that medication alone is not helping.
One tool she uses is the Pain Catastrophising Scale, a questionnaire that probes patients on three areas: rumination, when they think repetitively about their pain; magnification, when they perceive pain as more severe and threatening than what might be expected; and helplessness, when they feel they have no control over it.
The results help her tailor her treatment.
For some patients, cognitive behavioural therapy (CBT) helps. CBT works to get patients to notice and change negative thoughts and behaviour.
For others, acceptance and commitment therapy (ACT) guides them to accept pain as part of life but not let it control their actions.
For example, if a patient constantly ruminates about how unfair it is to live with chronic pain, Ms Sum will help them see that dwelling on these thoughts doesn’t bring relief, and that it might be more productive to focus on what they are currently doing instead.
In another case, a patient with chronic knee pain might avoid going out with friends. She will work to uncover the root of these fears. “Is it that they might fall, or that if they fall, there will be no one there to help them? We then try to come to a more balanced way of thinking.”
She will help the patient take practical measures such as adding family members’ phone numbers to their phone’s speed dial. To rebuild confidence, the patient will be guided to start with short walks, gradually building up the distances.
Patients are also taught relaxation and mindfulness techniques to redirect their attention to things within their control, such as their breathing.
“When they are willing to engage in the strategies that we teach, they go on to be able to do the things that they want to do, which is very nice to see,” she said.
