Psychological Components of Chronic Pain

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Biology 202
2004 Second Web Paper
On Serendip

Psychological Components of Chronic Pain

Natalie Merrill

My sister suffers from a chronic autoimmune disease associated with chronic pain and fatigue. Over the years I have witnessed her struggle with the disease and observed her symptoms fluctuate with her mood. Am I suggesting she is faking her symptoms, forgetting them when happy or exaggerating them when down? Certainly not; I have merely noticed a common trend: mental state affects physical state. What is this unique mind-body connection? And how can one's mental state affect one's physical perceptions?

Upon my online investigation of chronic pain, I discovered the constant distinction being noted between ACUTE and CHRONIC pain. Acute pain is typically natural and 'healthy' pain. Pain normally serves a very useful function: to warn us of danger and to protect our bodies. "Without pain we would have no way of knowing that something was wrong" and would "be unable to take action to correct the problem or situation that is causing the pain" (1). Acute pain is short-term and involves a physically observable or physiologically provable source. Chronic pain, however, is persistent or recurrent, lasting for "at least three months and most probably for several years" (2). This is not considered a healthy body response especially with apparent nonexistent stimuli.

The problem is that this chronic pain has no specific etiology. There is no diagnostic test that can be done to prove you suffer from chronic pain (though tests have been done compare brain states of patients with increased pain sensitivity to touch to equal pain inducing stimuli in patients with 'normal' sensitivity that have found that those experiences produce similar brain states). There is also no proof of the exact psychological processes involved in the experience and management of chronic pain. Does chronic pain cause a bad mood, depression, anger, and anxiety or do those states cause chronic pain? It seems that no one really knows; "the exact medical causes of the chronic pain condition are unknown or poorly understood" (2). Research seems to suggest that the relationships are reflexive, Thomas A. reports that "pain and psychological illness have reciprocal psychological and behavioral effects" implicating a co-morbidity of depression and pain (3).

Again though, there does not seem to be a discernable cause for this chronic pain, nor its association with depression. Perhaps this is why in all my reading chronic pain is constantly being defended. Consider the following examples:


"Emotional stress and negative thinking can actually increase the intensity of the pain, but the presence of psychological factors does not mean that the pain is imaginary" (1).

"We've all heard it before: 'It's in your head'" (4).

:

"Sometimes those with chronic pain are blamed for their condition or made to feel like they were making it all up..." (2).

Where does the need come from to defend chronic pain against accusations that it is 'imaginary,' in one's head or, just a lie? Why is it necessary to declare chronic pain as real? Apparently this question seems to be the real one. Dr. Nortin M. Hadler reports that the "escalating discordance between feeling miserable and possessing no demonstrable primary pathophysiology" is a byproduct of a brand of medical science and the real problem with treating chronic pain (5). The western biomedical approach, with its focus on diagnosis and labeling as well as its symptomatic definition of health has produced a pathological focus in healing that mal-socializes patients and doctors to define disease in a detrimental way.

Western medicine is based on a specific duality that has pervaded culture since Descartes first separated mind and body. By treating the mind and body as separate, one is forced into having either a physical or mental ailment. "Reductionistic clinical thinking that has enslaved western physicians for generations" induces physicians to diagnose and label a disease along those specific and separate lines mind or body (1). Patients begin to feel as though their disease must be one or the other, and for chronic pain sufferers, without a specific etiology to blame, western medicine turns to the other source: the mind.

I realize I am quite a distance from where I started. I began wanting to know how mood might affect pain or disease and general and have ended with a critique of our medical culture. The problems with our conceptualization of disease are numerous and I could spend volumes discussing the issue. Dr. Bennett argues that we should avoid using labels that, once culturally defined, stigmatize the patient. However this process is engrained in other spheres of our life as well, certainly it is something we cannot avoid without a great deal of social change. "To understand the language of pain, we must learn to listen to how the pain echoes and reverberates between the physical, psychological, and social dimensions of the human condition" and this is not something easy to do for patients and doctors both (1). As a sociologist currently looking at social movements, I can't help but wonder what sort of a collective behavior would be needed to change the way we define health, science and ourselves as both social and biological agents of action.


References


Works Cited:

1. http://www.addiction-free.com/pain_management_&_addiction_psycho_components_of_pain.htm

2. http://www.aboutarachnoiditis.org/website_captures/chronicpainhandbook/

3. http://rockhawk.com/chronic_pain_and_depression.htm

4. http://webhome.idirect.com/~readon/pain.html

5. http://www.rheuma21st.com/archives/cutting_edge_fibromyalgia.html

Works Consulted:

1. http://www.mindpub.com/art203.htm

2. http://www.pearsonassessments.com/resources/painprofile.htm


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