How can we, as treatment providers, help to shape patients’ expectations such that they approach their pain treatment feeling positive and confident? How can patients support their own pain treatment with a sense of self-efficacy? Associate Professor Dr. Regine Klinger tackles such questions at the University Medical Center Hamburg-Eppendorf.
Dr. Regine Klinger – Head of Psychology in the Section for Pain Medicine and Pain Psychology at the Department of Anesthesiology, University Medical Center Hamburg Eppendorf
Positive treatment expectations can strengthen patients’ self-efficacy and contribute substantially to pain relief.
Associate Professor Dr. Regine Klinger, Head of Psychology in the Section for Pain Medicine and Pain Psychology at the Department of Anesthesiology, University Medical Center Hamburg-Eppendorf
I am the Head of Psychology in the Section for Pain Medicine and Pain Psychology at the Department of Anesthesiology, University Medical Center Hamburg Eppendorf (UKE). Here at the UKE, we have a large department for the treatment of chronic pain. For example, we treat patients with chronic back pain, headache, post-herpetic neuralgia, chronic complex regional pain syndrome (CRPS), fibromyalgia, or chronic rheumatic diseases. In our interdisciplinary, multimodal outpatient pain clinic, as well as at our UKE pain day clinic, patients are taught how to optimize their pain medication by learning pain psychology techniques and how to enhance medication effects in a self-effective way. Our patients are given a lot of information and learn how to better understand their pain and to activate their body’s own pain relief system in a targeted way. Expectations about their pain treatment play an important role in this regard.
We also treat acute postoperative pain. Acute pain can be experienced in very different ways and is influenced by a lot of different emotional and psychological factors, such as attention, fear of pain, anxiety about how it may develop further and about how everything is going to turn out, and whether the sufferer shows a tendency to catastrophize about the pain. The communication with practitioners is important here, as it has a substantial influence on these factors, for instance when practitioners show empathy towards the patient.
I also devote a lot of my time to research. As a psychological pain therapist on the one hand and a pain researcher on the other, my team and I are primarily interested in the many fascinating questions about how pain sufferers can do things themselves to “kick-start” their pain relief system:
- How can we, as practitioners, manage patients’ expectations such that they enter into their pain treatment feeling positive and confident?
- How can patients support their own pain treatment with a sense of self-efficacy, thus helping to enhance their confidence that the treatment will go well?
- Can this self-efficacy be intensified with the help of additional symbolic aspects, e.g. placebos that patients know to be placebos?
I am committed to answering these questions with my research. I am convinced that in this way, we will be able to further improve the treatment of chronic pain, and also of acute pain after an operation. I am always happy when patients understand and learn to apply these principles.
I studied psychology at the University of Trier and then trained as a clinical behavioural therapist. I have been a licensed psychological psychotherapist since 1999. Additionally, I completed further training in specialist pain psychotherapy with the German Society for Psychological Pain Therapy and Research. As a senior psychologist, I have set up both inpatient and several outpatient pain treatment clinics. I have always carried out my pain research in parallel with my clinical work, so it is very much oriented towards the clinical needs of the patients. I have been working as an associate professor at the University of Hamburg since 2011.
Dr. Regine Klinger: Pain and Pain Therapy
How I settled on the field of chronic pain and pain therapy
During my studies, I was especially interested in the area of medical psychology. The interplay between physical and psychological factors, right down to the level of the body’s calls, continues to fascinate me to this day. It also amazes me that the organism can learn pain and develop a pain memory. For many patients, this doesn’t seem real at the start of their treatment, because they see their pain exclusively as an expression of an injury or illness. In the course of treatment, they come to realize that the experience of pain is more than just the injury. They learn to understand their pain, to cope with it, and even to reduce it. They learn how to unlearn pain. Witnessing these moments moves me, and I would like to continue to scrutinize and research them. The question of how sufferers can use their own self-efficacy to change their experience of pain keeps driving me forwards.
Why I find placebo research so fascinating
My interest in placebo research began with my professional career in pain therapy, in the then newly established outpatient pain clinic at the University Hospital in Lübeck within the Clinic and Polyclinic for Anesthesiology. When working with the anaesthetists, I noticed that the same pain medication worked differently depending on which doctor had prescribed it. Over time, I realized that this difference in effectiveness depended on several factors: 1. How the pain medication was explained to the patients; 2. The context in which the patients took their medication, i.e. whether they took it consciously and unhurriedly, or “on the go” and haphazardly; and 3. Patients’ previous experience with medication. When I later looked into the learning and unlearning of pain, I came across the topic of the “analgesic placebo effect”. These factors that I had observed in my colleagues when prescribing medication, i.e. the varying information about a medication, the context in which it is taken, and previous experience with medication, are all influences that make up the placebo effect. They can all steer the patient’s expectation about the effectiveness of painkillers in a positive direction. Through their own power of expectation, patients can learn to trigger placebo effects in addition to their medication.
What brings me joy in life
The combination of my clinical work with the opportunity to work on these amazing research topics of treatment expectations – of the placebo effect – and of self-efficacy regarding pain, brings me great joy and I see my work as a positive challenge. I am further enriched by the wonderful collaboration within our CRC research network. I also appreciate my great research and clinical team. Thanks to our team spirit, the often difficult work is always fun and I enjoy coming up with solutions together. But despite all the work, family is the most important thing to me. In my private life, I love cooking for others and enjoying meals together in a fun, witty, and sociable atmosphere. I really like taking walks by the water, and I try to go jogging regularly – and am very happy when I manage it!