Chronic pain management: Psychological impact

Type of psychology: Addiction; Behavioral medicine; Clinical; Counseling; Health; Psychopathology; Psychotherapy

Chronic pain can be defined as a pervasive health condition that affects an individual's daily life, including episodes of increased pain, which affects ability to function physically and emotionally. Diagnosing and managing chronic pain can be a lifelong battle leading to psychological distress and physical disability.

Introduction

A pain-free life is something that most of us take for granted. Pain is a phenomenon that we experience in episodes such as falling off a ladder, breaking an arm, or waking up with a headache from too much champagne the previous night. Most experiences of pain are short lived and diminish quickly over time. Our ideas of health and wellness often revolve around the absence of pain; therefore overall well-being can be quantified by the level of pain experienced on a daily basis.

With lack of pain topping the list of what defines a healthy life, those who suffer from chronic pain may struggle with even the most mundane of tasks. A 2011 Global Industry Analysts report estimated that 1.5 billion people suffer from chronic pain conditions in the world on a daily basis. In the United States, chronic pain has been suggested to be the top cause of people seeking medical attention, costing as much as $635 billion annually in health care and lost work productivity, according to a 2011 report from the Institute of Medicine. The magnitude of this problem is vast and can be extremely complicated due to the challenge in understanding the cause, diagnosis, and methods to treat chronic pain. It is necessary for knowledge to spread in order to support those around us who battle pain every day of their lives.

Chronic Pain

Chronic pain can be described as mild to severe pain that has been present for six months or longer. This pain can be due to an injury, illness, or a specific chronic pain diagnosis such as fibromyalgia. The 2012 National Health Interview Survey estimated that approximately 25 million American adults were living with chronic pain, as defined by experiencing pain daily for three months. The impact of chronic pain can vary as much as the severity from something as mild as a headache or as severe as debilitating, widespread pain. People dealing with these symptoms often experience an overall change or challenge to their abilities and functioning level. This impact also will vary with the severity and frequency that the person experiences the pain symptoms. Chronic headaches may occur once a month and require the person to take the day off work, while a person with fibromyalgia or lupus may be rendered disabled. Because pain is a non-tangible, subjective, and personal experience, it can be challenging to determine the necessary treatment and level of disability. This is the reason that chronic pain is often undiagnosed, misdiagnosed, or ignored for long periods of time.

Types and Sources of Chronic Pain

As previously stated, chronic pain ranges in severity, frequency, and duration. The source of pain may be known as in the instance of injury. It could be the result of an illness that was either cured or uncured. Diabetes is a common cause of chronic pain and affected 22 million Americans as of 2014, according to the Centers for Disease Control and Prevention. In other instances such as chronic joint pain or headaches, the root of the pain may not be identified. Regardless of whether the cause of the chronic pain is known or unknown, it can be classified by the level of disturbance to one's overall functioning and ability to participate in previously enjoyable activities. People often seek medical attention when pain becomes overwhelming or negatively impacts their lives, such as difficulty performing work requirements or household tasks.

Diagnosis

Because pain is a subjective experience, medical professionals often find it a challenge to accurately diagnosis chronic pain. Medical professionals must rely on the patient's self-description of pain to determine how to explore causes and treatments. Because each person will have different ways in which he or she experiences and describes pain, diagnosing chronic pain is often a difficult task. It may take many years to arrive at an accurate diagnosis and correct treatment. For patients suffering from widespread chronic pain like fibromyalgia, this is a common occurrence. These individuals often tell stories of many years of seeking out numerous doctors and specialists without any relief. Each doctor may have a different option or hypothesis of what is causing the pain, which leads down different diagnostic and treatment paths. Exploring these different avenues can take months or even years to rule out specific disorders and may cause increased stress on the person who is experiencing chronic pain. Due to the burden of searching for help, including the variety of interventions and treatments attempted, the person may even give up before finding any relief.

Psychological Impact

Chronic pain is linked to many psychological issues, especially depression and anxiety. People suffering from long-lasting pain may experience intense emotional distress based on both physical and emotional impacts. The physical experience of pain links to the stress of a constant search for a cure, doctor's appointments, and the participation in both conventional medicine and/or holistic treatments. The management of care, including time and financial burden, can itself cause extensive emotional stress. Even the least invasive of treatments can be pricey, leaving people with chronic pain constantly paying for care, and the cost of medical bills alone can put people into financial hardship, adding further stress and forcing the need to make difficult decisions regarding how to manage care.

Based on the severity and frequency of the chronic pain, the person may have difficulty keeping regular employment, and chronic pain is a common reason people file for disability insurance.

The emotional strife of dealing with chronic pain can lead to further and more severe mental struggles. Depression, anxiety, and long-lasting fatigue can decrease the body's ability to produce natural painkillers. Therefore, the experience of chronic pain coupled with psychological struggle can exacerbate pain's severity, frequency, and duration. As chronic pain adds to emotional turmoil, it also leads to a breakdown of the immune system needed to fight disease. Those suffering with chronic pain are more susceptible to other common illnesses such as cold or flu. As this negative cycle continues, the person dealing with chronic pain is apt to become even more depressed, anxious, angry, and fatigued. The psychological impact of chronic pain will vary for each person based on many biopsychosocial factors. Unfortunately for those experiencing chronic pain, the physical pain and emotional strife seem to influence the other, and as the physical pain worsens the psychological struggle may also worsen. Some types of chronic pain, including migraine headaches, back pain, and pain with no known, specific cause, may even be associated with a higher risk of suicide.

Psychological Treatment

Although chronic pain patients are often in search of a cure to their suffering, most treatment plans only have the ability to stabilize and manage the pain. As this news often comes with extreme disappointment and sadness, emotional support and mental health counseling can be very beneficial. Coping with the loss of living a pain-free life can put the chronic pain sufferer into an intense depression accompanied with anger and anxiety. Because chronic pain is an invisible ailment, it is often overlooked or not understood by others. Even people closest to the individual experiencing chronic pain may not be able to understand the extent of struggle the person is experiencing. This may come across as invalidating or hurtful to the person suffering and may create further difficulties. On the other hand, even if family, friends, and employers are supportive, they may still not have the ability to fully comprehend the limitations that the person is feeling. It can be hard to quantify the level of debilitation that chronic fatigue or headaches may cause. A person experiencing chronic pain may feel very alone in his or her suffering. Therefore, having a therapist, counselor, or support group is very important. Finding others to share the struggle greatly alleviates the emotional turmoil these people are feeling. Moreover, support groups are know to be beneficial because having the ability to discuss and process the challenge of managing chronic pain validates the chronic pain experience and serves as a source of pain management solutions. Thus, in addition to any medical or holistic treatment options offered, mental health support is also recommended as part of treatment. Antidepressant or antianxiety medications may also help those with chronic pain who are also struggling with depression or anxiety. Taking an all-encompassing holistic approach is the most inclusive arena for helping the person suffering with chronic pain.

Because chronic pain is generally not a curable condition, the treatment goal revolves around helping the person return to a normal level of functioning. This includes being able to manage daily routines, such as work, household management, and recreational activities. Again this will vary for each person and will be measured by the individual experiencing the pain.

Medications and Surgery

Common treatments of chronic pain include pain medications and nerve-blocking medications. Medical professionals may recommend anything from aspirin to prescription narcotics. Nerve-blocking medications are often used to treat fibromyalgia, which is known to cause overactive and oversensitive nerves resulting in chronic pain. Often people who experience migraines or suffer from diabetes are on a regiment of medications to manage symptoms. As opioid addiction has become more prevalent in the United States, there is increasing debate about when, whether, and how much of these powerful painkillers should be prescribed, adding another layer of complication for patients facing chronic pain.

In some cases, surgeries or electrical stimulations are used when medications do not prove to be effective. These more invasive options range in effectiveness and may leave the individual deeply disappointed if they do not alleviate symptoms. Surgery is a common option for those experiencing chronic back pain. These invasive surgeries can result in pain and long recoveries; however, the possibility of reduced pain motivates many individuals to choose this option.

Holistic Treatments

Many people in the United States begin their treatment with traditional Western medicine options. Along with medication or surgery, rehabilitation such as physical therapy is often the next prescribed treatment. Physical therapy is most common when suffering occurs from a known injury that precipitates the chronic pain. Physical therapy may include stretching, strengthening, muscle stimulation, and other types of rehabilitation.

Another avenue often explored by those suffering with chronic pain is alternative or holistic medicine. Treatments include acupuncture, acupressure, biofeedback, chiropractic manipulation, massage therapy, meditation, and relaxation therapies. These alternative treatments are often used in conjunction with Western treatments. Other areas often explored are nutritional and exercise impacts and benefits. Meeting with nutritionists and exercise specialists can be extremely beneficial in managing chronic pain. Dietitians create diet plans for individuals experiencing chronic pain by including and excluding certain foods that may impact pain levels. Exercise is also suggested based on the person's mobility. Low-impact exercise such as swimming, walking, or Tai Chi may be recommended. Overall, health care professionals agree that maintaining health, including a balanced body weight and nutrition, has a large impact on the management of chronic pain.

Self-Management

As an individual journeys from being diagnosed with chronic pain to managing a treatment plan, he or she will need to take the driver's seat. It is very important for these individuals to self-manage care, because chronic pain is a unique and individual experience for each person. Doctors and health care professionals may have a variety of ideas to assist their patients, but a patient must be assertive in what has worked and what has not. Chronic pain sufferers also need to advocate for themselves through research and willingness to try different avenues of pain management. It is important to be educated in their unique issues and keep track of how different treatments, foods, exercise, and medication affect pain level. As their own self-care managers, patients have the ability to join a community of others who also experience and understand chronic pain, increase their knowledge of chronic pain, and find the best options for managing levels of pain and psychological distress.

Bibliography

Bullington, J., Rolf, N., Nordemar, K., & Sjöström-Flanagan, C. (2003). Meaning out of chaos: A way to understand chronic pain. Scandinavian Journal of Caring Sciences, 17(4), 325–331. DOI: 10.1046/j.0283–9318.2003.00244.x

Carlson, M. (2014). CBT for chronic pain and psychological well-being: A skills training manual integrating dbt, act, behavioral activation and motivational interviewing. Minneapolis, MN: Wiley-Blackwell.

Dennis, B. (2015, August 11). NIH: More than 1 in 10 American adults experience chronic pain. The Washington Post. Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2015/08/11/nih-more-than-1-in-10-american-adults-experience-chronic-pain

Greve, K. W., & Bianchini, K. J. (2012). The psychological assessment of pain-related disability. Coping with psychiatric and psychological testimony Based on the original work by Jay Ziskin (6th ed.). Faust, David (Ed); New York, NY: Oxford University Press.

Heverly, J. (2007). Chronic pain: Implications for therapy. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(6-B), 4132.

Lebovits, A. (2002). Psychological issues in the assessment and management of chronic pain. Annals of the American Psychotherapy Association, 5(3), 19–21.

Martin, R. (2014, December 21). For those suffering chronic pain, the hardest part is convincing others. NPR. Retrieved from http://www.npr.org/2014/12/21/372257315/for-those-suffering-chronic-pain-the-hardest-part-is-convincing-others

Seaman, A. M. (2013, May 24). Certain chronic pain may raise suicide risk. Reuters. Retrieved from http://www.reuters.com/article/us-chronic-pain-idUSBRE94N0WQ20130524