Pain Intro Notes

Harry L. Mills, Ph.D.

Pain is a mystery in medicine. The traditional view that pain is directly related to tissue damage is a workable theory in  only in a small number of cases. For example, 89% of back pain has an unknown cause. In the majority of cases a physical cause of headache cannot be determined. (Turk, 1997) Thus most researchers distinguish between nociception, which is the activation of nerves from tissue damage and the experience of pain, which involves memory, emotional responses and cognitive interpretation. Physical and psychological components interact to produce the experience of pain.

By its very nature psychological issues must be considered when approaching chronic pain. The self-regulation of pain involves behavioral, cognitive and affective elements. Learning can play a major role involving both classical and operant conditioning processes. Patient reaction to the cues associated with nausea and vomiting in chemotherapy can result in conditioned reactions to doctors, nurses and even clothes (Turk & Monarch, 2003).

Cognitive formulations play a major role in our perception of pain. There is no better example than the belief shared by many pain patients that pain signifies ongoing tissue damage or progression of a disease. The belief leads to more suffering for chronic pain patients. Also catastrophic thinking is common and it tends to elicit negative emotions that confound the pain experience. Another cognitive element that has received the attention of researchers is self-efficacy. The belief that there is something the patient can do about the pain seems very important in determining adjustment.

Affective states have a significant impact on pain. Depression, anxiety and anger have received the most attention. As many as 40 to 50% of pain patients suffer from depression (Turk & Monarch, 2003). Pain tends to hijack attention and too often negative emotions dominate the patient’s life. Fear, pain-related anxiety and preoccupation with the avoidance of harm not only have a negative impact on quality of life but along with other emotions can have a very negative impact on adherence to treatment recommendations.

The Primary Care Psychologist can contribute to services for pain patients by providing services that include the following:

• Relaxation & meditation training
• Desensitization and exposure to feared activities
• Cognitive restructuring
• Problem solving training
• Coping skills training.

One-dimensional models are being replaced with multidimensional models that address sensory, affective, behavioral and cognitive aspects of pain. A self-regulation approach that defines the patient’s role as active rather than passive seem to hold the greatest promise.