Hypnotic techniques may be used to induce relaxation and may be combined with other cognitive-behavioral strategies. Hypnosis is effective in relieving pain in individuals who can concentrate well, use imagery, and who are motivated to practice. In the related technique, cognitive reappraisal, patients learn to monitor and evaluate negative thoughts and replace them with more positive thoughts and images. Both oral and written information and instructions should be provided about pain, pain assessment, and the use of drugs and other methods of pain relief. Patient education should emphasize that almost all pain can be effectively managed.
Some patients benefit from short-term psychotherapy provided by trained professionals.
Patients whose pain is particularly difficult to manage and who develop symptoms of clinical depression or adjustment disorder should be referred to a psychiatrist for diagnosis. The relationship between poorly controlled pain, depression, and thoughts of suicide should not be ignored. Because many patients benefit from peer support groups, clinicians should be aware of locally active groups and offer this information to patients and their families. Pastoral counseling members of the health care team should participate in meetings to discuss patients' needs and treatment. They should be a source of information on community resources for spiritual care and social support.