Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The pain you feel involves the interaction between tissues, genetics, current health, emotional state, past experiences with pain, beliefs and thoughts about pain.

 

There are two basic types of pain. Nociceptive pain and Neuropathic pain:

 1. Nociceptive pain is caused by damage or disease to body tissue outside the nervous system. The pain can be dull, aching, throbbing and occasionally sharp. Examples are sciatica pain, degenerative disc disease and cancer pain.

 2. Neuropathic pain is caused by damage to the nervous system. The pain can be experienced as burning, tingling, shooting, stabbing and electrical pain. Examples are Neuralgia, Complex Regional Pain Syndrome, Failed Back Syndrome and Radiculopathies. Neuropathic pain is seen as more severe because it is less responsive to analgesic drugs and conventional medical management.

 

Pain is classified as either “acute” or “chronic”. Pain becomes chronic when it persists for six months despite treatment. If acute pain can be symbolized as a feather then chronic pain would be a brick. The following are some of the not so subtle differences between chronic and acute pain.

 

CHRONIC	ACUTE
Long Term (no end in sight)	Short Term
Reason not clear	Reason explainable, treatable
Questions arise about motives and behavior (drugs)	Help is offered and there is honor in accepting
Invisible	Recognized
Legal system treats patient as a Criminal who must prove his/her innocence	Convalescence is culturally, politically, and socially accepted
Pain is a barrier	Pain is a speed bump
Pain is unnatural	Pain is natural
Healing is a puzzle	Healing is predictable
Doctor in charge	Patient in charge
Helpless and ashamed	Empowered by healing
No effective treatment	Leads to treatment
Doctors seem doubting and unhelpful	Doctor is seen as helpful and encouraging
Something going wrong	Body working right
Pain as meaningless	Pain is a warning
No effective treatment	Leads to treatment

 

COSTS OF PAIN

* More than 105 million Americans live with chronic pain.

* 50% report low back pain.

* Between the ages of 18 and 44, 23.9% of Americans report back pain and 12.4% report neck pain.

* Between the ages of 65 and older, 34% of Americans report back pain and 14.4% of Americans report neck pain.

* A 2004 report from the American Chronic Pain Association indicated that half of the chronic pain patients surveyed felt their pain wasn’t being controlled by their treatment.40% of chronic pain patients change doctors at least three times, reporting the reasons to be inadequate pain relief. Other reasons given were, they were not 1) taken seriously; 2) treated aggressively; or 3) understood.

* Fears of addiction, beliefs that pain is “just something to live with” or “pain is part of growing older”, disillusionment with available treatments and intimidation from those who believe pain “is all in your head” prevent many from seeking help that is available.

* Pain causes the majority of sufferers to experience anxiety, irritability and depression. The emotional and physical consequences of pain become self-perpetuating with pain leading to depression, irritability and anxiety which leads back to pain. Many pain patients suffer from an inability to sleep.

* Walter Stewart, Ph.D. reported in a recent article in the Journal of American Medical Association that businesses lose 61.2 billion per year on loss of productivity due to pain.
 

There are many costs to chronic pain that are not tallied in the research. Costs related to:

      • Eating out

      • Out of pocket co-pays

      • Transportation to treatments

      • Over the counter medications

 

How does one estimate the value of self-worth or estimate the cost of stress in a family and among friends?

How does one estimate the value of a loss of a sense of accomplishment?

 

Worsening of one’s health is a natural consequence of increased stress and inactivity which can lead to heart disease, overweight and diabetes

 

PSYCHOLOGICAL APPROACHES TO PAIN MANAGEMENT

Psychological factors such as mood, beliefs about pain, and coping styles have been found to play an important role in a pain patient’s adjustment to symptoms. There are many Pain Myths that need to be addressed when learning to control symptoms

As the pain patient withdraws and becomes less active their muscles may become weaker, they may begin to gain or lose weight and their overall physical conditioning may decline. Their being out of condition can cause their pain to increase rapidly when attempting minor tasks; this can contribute to a belief that one is disabled. Negative thoughts as well as decreased participation in enjoyable and reinforcing activities can lead a person to feel depressed and anxious.

There is firm evidence in research literature that cognitive-behavioral treatments are effective in reducing clients’ pain levels, use of pain medications, negative thoughts, extent of physical disability as well as enhancing clients’ pain control, emotions, physical functioning, health status, and relationships with others compared to not being in therapy at all (Morley, Eccleston, & Williams, 1999, van Tulder et al., 2000).

People suffering from chronic lower back pain may find relief through cognitive behavioral therapy. This trial shows that a cognitive behavioral intervention package is effective in managing subacute and chronic low-back pain in primary care. Therapy costs about half of other treatments, such as acupuncture, the researchers noted. The Lancet DOI: 10.1016/S0140-6736(09)62164-4

Cognitive Behavioral Therapy for Fibromyalgia Over the past 18 years several chronic pain treatment programs have used CBT techniques in the management of Fibromyalgia. Importantly the beneficial effects of CBT can be achieved in 10-20 sessions. –Robert Bennett and David Nelson, nature.com/clinicalpractice/rheum

It is possible to learn to enjoy life again. Cognitive behavioral therapy includes: 1) relaxation training, 2) cognitive restructuring, 3) stress and anger management, 4) sleep hygiene, and 5) activity pacing.

 

Cognitive behavioral therapy has been found to be highly effective in helping patients reduce pain, disability and distress. It involves modifying negative thoughts related to pain (i.e. This pain is going to kill me., I’m worthless, Nobody would want me if I can’t work.) and on increasing a person’s activity level and productive functioning. It has been shown to be highly effective in promoting positive cognitive and behavioral changes in individuals with chronic pain.