Attitudes toward and Knowledge of Chronic Pain: A Survey of Medical Social Workers

Article excerpt

Chronic pain inflicts a staggering, though often unrecognized, toll on society. Over a decade ago, Golden and Steiner (1981) suggested that chronic pain was the United States's most costly health problem. Since that time it has been estimated that 88 million people in the United States suffer from clinically significant levels of acute and chronic pain annually. Of these, 77 million individuals suffer from chronic pain (Wu & Grzesiak, 1987). Low back pain alone affects over 8 million Americans annually, making this affliction the major cause of disability in people under 45 years of age (Mims, 1989). Turk, Meichenbaum, and Genest (1983) stated that over $900 million was spent on over-the-counter analgesics and other related products in 1983. These and other consequences of pain translate into a cost of at least $60 billion a year for the United States, and the costs in terms of human suffering cannot be measured (Kodiath, 1991; Wu & Grzesiak, 1987).

Chronic pain affects much more than somatic or bodily functions. It also has significant and enduring psychosocial effects. For example, the sufferer of chronic pain has usually endured numerous unsuccessful medical interventions (Roy, 1981; Turk & Rudy, 1989). This fruitless search for health becomes a focal point of the patient's life. It disrupts family roles and relationships, destroys careers, and causes the individual to withdraw into personal isolation. It creates a sense of hopelessness and helplessness, which further erodes psychological functioning. In short, chronic pain can cause severe emotional, physical, economic, and social problems for the patient (Crue, 1988; Roy, 1985; Subramanian & Rose, 1988b; Vasudevan, 1988; Wall, 1989).

Unfortunately, it can be argued that current health care policies, structures, and practices in Canada and the United States do not adequately alleviate the problems and costs associated with chronic pain. These systems are built on the acute illness model, which has encountered limited success in assessing and treating pain of a chronic nature (Benjamin, 1989; Craig, 1984; Garon, 1991; Kodiath, 1991; Melzack, 1973; Melzack & Wall, 1988; Mims, 1989). Medical professionals often cannot provide relief to chronic pain sufferers through traditional medical techniques. As a result, patients engage in an urgent search for answers to their pain while coping with its concomitant hopelessness, despair, and depression (Wall, 1989).

A relatively recent trend in chronic pain management has shown promise in breaking the ongoing cycle of pain and medical treatment for pain patients. This trend is shifting toward a more holistic, comprehensive, and multidisciplinary model. As a result, more and more helping professions, including the social work profession, are becoming directly involved in the treatment of chronic pain (Aronoff & Mcalary, 1988).

Because the traditional medical model is not sufficient for managing chronic pain, a useful approach to assessment and treatment is the ecological systems model used by many social workers (Subramanian, 1987, 1991a, 1991b, 1994; Subramanian & Rose, 1988b). This model allows for the evaluation of personal, psychological, social, and situational factors in a thorough assessment of the pain experience. It also provides the basis for cognitive - behavioral interventions that recognize the full range of personal and environmental realities inherent in the patient's experience of pain.

Social work is in an extraordinary position to broaden the research base on both the assessment and treatment of chronic pain (Subramanian, 1987, 1991a, 1991b, 1994; Subramanian & Rose, 1988b). Social workers are becoming more commonly represented in multidisciplinary pain centers (Subramanian, 1994), and social workers provide services in settings other than pain clinics to many clients who suffer from chronic pain (Subramanian, 1991b, 1994). In general, social workers are likely to find increasing numbers of clients whose presenting problems involve chronic pain. …