A DECONSTRUCTIVE TURN IN CHRONIC PAIN TREATMENT: A Redefined Role for Social Work

By MacDonald, Judy E. | Health and Social Work, February 2000 | Go to article overview

A DECONSTRUCTIVE TURN IN CHRONIC PAIN TREATMENT: A Redefined Role for Social Work


MacDonald, Judy E., Health and Social Work


Chronic pain treatment programs in North America are based predominantly on a behavioral science model of contingency management, whereby the focus of treatment is directed toward the psychological aspects of pain. Treatment objectives are designed to eliminate reinforcing environmental contingencies, thus changing pain behavior and reestablishing well behavior. The purpose of this article is to displace the contingency management model with deconstruction and thus present an alternative conceptualization based on the experiences of chronic pain sufferers. Social work's value base of self-determination and empowerment upholds these challenges to the predominant treatment model. Alternative social work interventions are explored.

Chronic pain has captured growing attention in the medical and health care professions during the past 25 years, becoming a complex problem of major medical, social, economic, and personal proportion. Chronic pain has been estimated to cost between 60 billion and 65 billion dollars and 700 million workdays annually in the United States (Blackwell, 1989; Sieppert, 1996). Health care costs, lost work hours, and compensation have been cited as key areas of concern throughout the research literature. The personal costs of chronic pain need to be recognized and validated, because chronic pain sufferers cannot elude pain characterized as "evasive:' "overwhelming' "isolating:' "horrendous," and "unbearable" (Rose, 1994; Seers & Friedli, 1996).

Chronic pain treatment has been conceptualized predominantly in a medical model, with growing emphasis on the psychological behavioral components (Bonica, 1990). Causation has been defined in three classifications: malignant, non-malignant, and idiopathic. In the first two classifications, identifiable pathology can be specified, whereas in the third no sign of tissue damage is apparent or the pain appears disproportionate to the physical cause (Bendelow & Williams, 1995). The diagnostic and treatment processes applied to patients classified with idiopathic pain is the presented concern and focus of this article. With the diagnosis of idiopathic pain, an emphasis emerges on "chronic pain behavior resulting primarily from reinforcing environmental influences or so-called operant mechanisms" (Bonica, p. 201), leading to a behavioral science model of contingency management. Contingency is defined as "the consequences that are expected to follow behaviors," whereby "the consequences of a given behavior largely i nfluence the future occurrence of that behavior" (Barker, 1997, p. 78). Chronic pain treatment thus focuses on the management of patients' behaviors, distinguishing pain behaviors through the withdrawal of reinforcing influences; for example, expressions of pain would be ignored by the health care team. Once environmental contingencies that reinforce sick (pain) behavior are eliminated, well behavior is re-established (Bonica; Fordyce, 1990; Loeser, Seres, & Newman, 1990).

From a social work perspective, this article challenges the premises on which this behaviorist approach to chronic pain is founded, follows contingency assessment through to its implications for chronic sufferers, and makes space for an alternative approach guided by the "voices of sufferers." Researchers and practitioners repeatedly highlight the necessity of trust, empathy, respect, and empowerment in service delivery to chronic pain patients (Lipkin, 1989; Marcus, 1986; Murray, 1997; Pilowsky & Barrow, 1990; Vrancken, 1989). Yet, the voices of sufferers reflect powerlessness and the fundamental need to have their pain believed (Howell, 1994; Miles, 1992; Seers & Friedli, 1996). This article uncovers the contradictions inherent in the contingency management model through the process of deconstruction. Deconstruction has been defined as an "analysis that takes apart socially constructed categories as a way of seeing how a particular world view is constructed" (Ristock & Pennell, 1996, p. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

A DECONSTRUCTIVE TURN IN CHRONIC PAIN TREATMENT: A Redefined Role for Social Work
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.