- Chronic Pain: The Psychological Connection
It is obvious that physical injury is often associated with pain. What is less obvious, is that pain always has a psychological connection, and that connection can be so powerful that the pain which should help survival can destroy life. On the other hand, psychological forces can eliminate pain, at least temporarily.
There are many people to whom such ideas seem far fetched. Perhaps they've never met people who have tried to end their lives because of the endless nagging pain they suffer or those who learned to reduce their pain through deep relaxation or self hypnosis have (I'm using the terms deep relaxation or self hypnosis to mean the same thing).
Many otherwise well educated professionals seem to believe that there is a one to one relationship between organic injury and pain. Of course there is not. The same people may be in agony on one occasion when they cut themselves in their kitchen, and scarcely notice a similar injury when it happens during a sporting contest.
Further, pain is not the only direct consequence of physical injury. Pain itself always creates a stress response. Not sometimes; always. With persisting pain this stress reaction usually makes the pain feel worse, it increases the suffering. It is truly a vicious circle. Pain creates a stress response; this stress creates more pain; this greater pain causes more stress; and so on.
This problem can be treated in medical ways such as by using of painkilling drugs. It can also be changed by psychological means. People with serious pain will inevitably require both types of management since painkillers are rarely enough by themselves, and they have many undesirable side effects.
Many of the other effects that are directly related to chronic pain – like mood change, family conflict, job loss, lifestyle change - do not respond well to medical treatment at all. People whose moods are affected by nagging pain, may need to learn ways to take "time out" from their pain, and may appreciate the opportunity to ventilate their feelings to someone outside the family circle. Those with relationship and lifestyle issues may require counselling.
Perhaps the most obvious problem that is psychological in orientation, is cognitive deficiency (problems with thinking) associated with stress or with the injury itself. The most common difficulty is loss of concentration, and therefore a lapse in short term memory. People in chronic pain are very forgetful. Some research suggests that as many as two thirds of people with long term injuries suffer from cognitive difficulties.
Memory loss caused by pain induced stress may be relieved by stress management programs. This is a relatively inexpensive kind of intervention. But if the memory problems are caused by brain damage, long term therapeutic efforts may be required. Research suggests that with extensive retraining some people can learn to bring bring other parts of their brain into action to take over from the injured areas. The reality is that few people are ever exposed to such intervention.
One of the most insidious effects of chronic pain is the development of dependency for painkilling drugs. The body systems go through a truly weird process in which the individual who has been having a lot of analgesics experiences an increase in pain until the drug is supplied. As you can imagine, this makes it very hard to get off the drugs. Typically the pain gets worse and worse in the early stages of stopping drug therapy.
The most widely cited theory about pain is one proposed by American researchers, Psychologist Melzack and his colleague Wall. Their research suggested that pain signals go through a kind of gate system in the spine which is responsive to other signals that come from the higher centres of the brain. These higher centres determine how the signals are finally experienced.
Up to a certain level of intensity pain signals may simply pass through the spinal gate and be received at the brain as a pretty direct representation of the strength of the stimulus. However, very high intensity pain signals, or other feedback that starts in the thinking areas of the brain, may cause the gate to shut for a time, stopping the perception of pain. Thus people suffering serious injury may feel little pain at first – as a result of the intense signals causing a shutdown - and people in hypnosis may be able to directly shut off pain. Melzack believes that it is this process that some people learn to apply through deep relaxation/self-hypnosis.
More readings will be added to my blog from time to time. Have a quick look now to see the first posting on my blog PSYC1PLUS