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Most Unhelpful Myths
About Chronic Painby Mark Grant MA
Pain has traditionally been considered to be a 'signal' of physical injury. This warning type of pain is called acute pain. Chronic pain refers to pain that continues after the normal healing time, or when the injury appears to have healed.
Chronic pain can be caused by muscle tension, changes in circulation, postural imbalances, psychological distress and neurological changes. It is also known that unrelieved pain is associated with increased metabolic rate, spontaneous excitation of the central nervous system, changes in blood circulation in the brain, and changes in the limbic-hypothalmic system (responsible for emotions). The involvement of neurological processes explains why chronic pain can occur in the absence of external stimulation. So pain can be caused by many things, and chronic pain in particular cannot be understood in terms of the simple physical injury = pain model.Chronic pain is also not always what it appears. Sometimes pain is labelled "chronic" when it has lasted a long time and the cause cannot be ascertained. Where the cause of pain is unknown, it is not strictly correct to label this chronic pain, since the pain may be signaling some injury that is undiscovered. Or the pain may include 'flare-ups' caused by over-activity, in which case it is really acute pain. At the end of the day, you have to decide what your pain means, based on a combination of medical advice and your own opinions.
Although we now know that pain is caused and maintained by a combination of physical, psychological and neurological factors, many people continue to act as though it can be understood in terms of physical pathology. For example, surgeons who tell patients "well the operation was a success, you shouldn't be in pain.' or doctors who refuse to prescribe medication to people because they cannot find a physical cause for the pain. The notion that pain should be proportional to injury is an old but very popular idea which comes from the specificity theory of pain which proposes that pain is caused by physical injury. Despite its continuing popularity in popular consciousness, this theory has many problems and was abandoned over 30 years ago. One of the problems of specificity theory was its inability to explain the high number of people who have pain despite there being no obvious physical cause. For example, a survey in the USA a few years ago, of 10,000 cases of low back pain, found that in over 75% of cases there was no adequate medical explanation for the pain. It seems unlikely that all these people's pain is 'psychological'. The discovery of the role of neurological processes also means that pain that occurs in the absence of detectable external stimulation should not be considered abnormal. Rather than saying pain is all "in the mind" we can say that we can say is that it is "in the brain".
As ridiculous as this sounds, many people act as though it were true. Pain sufferers do this by not complaining about pain, by persisting with behaviors that only aggravate their pain, and by ignoring signs that their pain is inadequately controlled (eg; irritability, poor sleep) instead of doing something about it. Treating specialists do this by withholding effective medication or encouraging activities that unduely aggravate the pain. Chronic pain sufferers are more likely to suffer from anxiety, depression, suicidal thoughts, trauma, family problems and a range of other psychological symptoms. Unrelieved chronic pain is soul-destroying, not character-building.
Many cultures see the ability to withstand pain as a sign of strength. This ability would certainly have had survival value in past more war-like societies. Although times have changed, we can see an echo of this tradition today when people are afraid to talk about their pain for fear of being labelled a complainer or weak. Not reporting pain can lead to poor management of injury, medical mismanagement, as well as increasing the likelihood of chronic pain and depression. Pain can only be overcome if it is acknowledged and expressed.
'Secondary gain' is the medical jargon for any apparent benefit the patient gains from being in pain, such as attention, financial compensation etc. 'Secondary gain' can be used to imply that the sufferer is hanging onto his/her pain, which usually only makes the pain sufferer feel guilty and judged. For most pain sufferers, secondary gains are rarely more desirable than having their health and life back. Research has also shown that exaggerating about pain or malingering is actually rare. Even if someone is holding onto their pain as it were, they should not be judged for this. It is more constructive to find the reasons behind this and deal with them.
The doctor-patient relationship has traditionally meant the patient adopting a humble and respectful attitude. Many of us are keenly aware of how busy our doctors are and reluctant to burden them with too many questions. Chronic pain is also a difficult problem for doctors to treat and we may be embarrassed to admit that, say, the medication wasn't effective. Unfortunately, this often leads to underreporting pain which is one of the major causes of failure of treatment. The doctor-patient relationship is always a two-way street. This is particularly so with pain which is invisible and does not show up on any scan, making the doctor totally dependent on what you tell him. It is not only important, it is your responsibility to tell your doctor what your symptoms are.
We place a lot of faith in the medical system. Sometimes there is a tendency to 'blame the patient' when treatment fails. However, a recent research report stated that Chronic pain is "grossly under-treated" in over 50% of cases. In a recent survey 50% of chronic pain patients had inadequate pain relief and had considered suicide to escape their pain. The truth is that pain management is an area of medicine that is acknowledged to be in a state of crisis.There are a number of reasons for this, including cultural, historical and scientific factors. For example, pain management is a relatively new speciality, it was not even taught at many medical schools until recently. Many people still dismiss pain that is not accompanied by an obvious physical injury. It bears repeating that if you have excessive pain, you must take responsibility for communicating any problems to your doctor - sometimes in spite of assurances that "we've done everything we can.."
With a few rare exceptions, there is no need for anybody to have to live with unbearable pain nowadays. Sometimes, after many investigations and different treatments, the pain can still be too much to bear. Don't give up. There are more treatment options available than ever before, ranging from advanced medical procedures to alternative approaches such as acupuncture, TENS machines and psychological approaches, to powerful opioids. Many people give up hope too soon because of fear or ignorance. Do not become discouraged, keep asking and looking for information.
You actually have a legal right to receive adequate pain-relief. In 1991 a health provider in the USA was successfully sued on the grounds of pain and suffering made intolerable by a nurse who needlessly withheld appropriate treatment (opioids) because she believed the patient to be addicted.
Mark Grant is a psychologist, specializing in the management of chronic pain and trauma. His advice is based on many years of clinical experience working with persons affected by chronic pain and trauma.
Mark has also conducted research regarding a multi-modal approach to pain management. He is the author of two self-help tapes which use ac
celerated learning principles for sufferers of chronic pain and stress: Calm and Confident based on EMDR and Pain Control, based on EMDR. He has also spoken at numerous international conferences and workshops about pain management.
Further reading: Salerno, Evelyn & Willens Joyce; Pain Management Handbook. C V Mosby & Co St. Louis 1996