| | - The International Association for the Study of Pain (IASP) defines pain as both a sensory and emotional experience. A specific diagnosis and definite tissue damage are also quite often elusive leaving the sufferer confused and concerned about the treatment and management of their pain problem.
- The person experiencing persistent pain do not only present with a history of pain, but also with a history of failed treatments contributing to distress.
- Pain is understood within the bio-psycho-social model. The body/brain producing pain messages quite often in the absence of serious or ongoing damage (bio). This causes the sufferer distress and anxiety about their future (psycho), while the persistent pain impacts significantly upon work, relationships, activities, hobbies and interests (social).
- Cognitive factors, such as the understanding and meaning of the pain; have been demonstrated to contribute strongly to both pain intensity and disability and as such, bio-psycho-social models of pain have developed in order to account for these findings. The Gate Control Theory of pain (Melzack & Wall, 1965) emphasises the importance of both psychological and physiological factors in the aetiology and maintenance of chronic pain.
- Cognitive-Behavioural Therapy for chronic pain emphasises the importance of cognitive processes including beliefs and attributions, and the impact these have upon both psychological and physical aspects of an individual. Such approaches aim to improve the physical, psychological, emotional and social dimensions of quality of life (The British Pain Society, 2007) as part of a multidisciplinary approach.
- Evidence: pain is tied to brain functions governing behaviour and decision making. Expectation, stress, and changes in mood alter pain intensity.
- Chronic Pain is not only a response of the whole brain; it is a response of the whole being.
- More evidence: The Chronic Pain experience sensitises the nervous system over time: less stimulation for the signal to be experienced as pain, resulting in the pain fluctuating and spreading throughout the body.
- Good news: The Pain system is highly developed: it can adjust to continued pain and reduce sensitivity (Flor 2000).
- Treatment: Cognitive behavioural therapy and exercise therapy recommended by the NICE Guidelines; The European Guidelines on the management of chronic low back pain and the British Pain Society.
- The brain and persistent pain: the brain interprets pain as a biological threat which is difficult or impossible to ignore. Its processing takes priority over almost all else: concentration, short-term memory and activities.
- Chronic Pain and the three “i’s” (Stephen Morley): Interfering with cognitive processing; interrupts activity and changes identity.
• Persistent pain poses the question “what should I do to minimise / eliminate the danger?” The sufferer understandable quite often responds with guarding and protecting painful areas; resting, and avoiding strain. This strategy results in muscles wasting, joints stiffening and an overall deterioration in fitness and strength. The result: pain intensifying over time; a reduction in activity and the mood becoming depressed and anxious. • The pain patient quite often receives conflicting explanations regarding a diagnosis and treatments from health professionals. They feel disbelieved, uncertain about the management of their condition and labeled as making it up or exaggerating the symptoms. • Professor Waddell: ‘Fear of pain and what we do about it may be more disabling than pain itself’. • Research: From a purely biological perspective, chronic pain differs fundamentally from acute pain inasmuch as pharmacological treatments targeted at symptom reduction are frequently ineffective, as they generally do not target the complex underlying processes involved in pain (Loeser & Melzack, 1999). • Fact: Chronic pain is one of the most common reasons for an individual to seek healthcare; has a significant negative impact upon general quality of life; mental health and can also impact upon marital and other relationships. • Jannie is a Chartered Consultant Clinical Psychologist specialising in Chronic Pain conditions. He has been treating people suffering from chronic pain for over a decade and his past experience includes being the Clinical Lead at the INPUT Pain Management Unit, St Thomas’ Hospital (London); setting up pain and persistent condition management programmes and seeing people with chronic pain on an individual basis. • He is a member of The International Association for the Study of Pain (IASP) and The British Psychological Society and has presented research locally and abroad. He has also published on Psychology and Pain. |
