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Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia
Pain is a subjective experience which can occur in very different qualities and strengths. Pain cannot be measured or objectified. Therefore in assessing the pain of a patient, dependency is on his verbal description, his nonverbal expressions and empathy. Problems with the communication between doctor and patient are a frequent result. Pain is still often only thought of in terms of its primary function, the warning function and it is rarely distinguished as acute or chronic pain.
However, the latter frequently follows very different rules. Influenced by an out-dated linear causal thinking, it is often assumed that pain is caused exclusively by a stimulation of a nociceptor. If then such an organ pathological discovery explaining the pain cannot be found, the patients’ experiences are not seldomly questioned. `You only imagine that’ patients sometimes hear; or one searches for further physical causes. This of course increases the conviction of the patients, their pain can only have physical causes (not yet found). All people involved then believe that it needs further diagnostic investigations in order to find the cause.
Patients are sent to the nth examination and increasingly are regarded as difficult or annoying. This is already the first step towards chronification. However, since the chances for cures sink drastically with increasing chronification, it is necessary to offer the patient an appropriate, that is interdisciplinary, diagnosis and treatment from the beginning. Therefore, this chapter is generally concerned with the bio-psycho-social control factors of the (acute) pain experience, further with chronic pain and finally with different integrative therapeutic approaches.
. duration of illness;
As frequently neither surgical nor medical treatments lead to a lasting success, the patient alternately experiences hope, disappointment, annoyance, further hope, if a new therapy method is attempted, and so forth. Finally, feelings of helplessness, depression, resignation evolve and the patient gradually withdraws from the outer world. However, the more days he has to take off because of his illness, the more he takes care of his body and the more he withdraws, the more attention is given to the body which is a risk for a renewed negative influence on the way pain is experienced.
This vicious circle also has an iatrogenic component. As known from prospective studies, if a patient, in his own subjective theory about his illness, only considers a physical cause and excludes psychological factors, this increases the probability of chronification. It therefore would be necessary, from the beginning on, not only to consider the (mistakenly) somatic causes of pain, but also to take as many as possible of the involved pathogenetic or modulating factors into account. As a result, the spiral of hope, disappointment and resignation can be prevented and the patient’s personal activity can be supported.
Diagnostic classification of chronic pain
Concepts explaining chronic pain
Both pathogenetic concepts have developed particular methods of treatment . The depth psychological concepts shall be discussed first.
To a considerable extent, these retrospective findings could also be confirmed in prospective studies. It turned out that a proneness for pain can actually be verified. The fact that traumas in childhood can be essential contributing factors for a later chronic pain are hardly questioned anymore. Continuous pains after a successfully completed back operation were found in patients with traumatizing experiences in childhood significantly more often than in patients without these traumas.
Therefore, it can be assumed that the personality development in early childhood also controls the later occurrence of chronic pains. However, it should be stressed that a dichotomy of `purely psychogenic’ or `purely physical’ pains, and how this was attempted in the 1970s, makes no sense. Chronic pain is always a result of an interaction of numerous factors (physical, psychological , social, cultural and last but not least, iatrogenic factors).
Reflection Exercise #3
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