Academic journal article Journal of Counseling and Development : JCD

Counseling Adult Clients Experiencing Chronic Pain

Academic journal article Journal of Counseling and Development : JCD

Counseling Adult Clients Experiencing Chronic Pain

Article excerpt

Pain is commonly defined as being caused by physical and/ or mental distress and is further classified into two separate groups. The first classification, acute pain, is characterized as being temporary and directly linked to tissue damage, existing for the purpose of preventing further injury, and lasting for no longer than 3 months. The second classification, chronic pain, is defined as pain without apparent biological value that has persisted beyond the normal tissue healing time of 3 months. Because chronic pain serves no productive function and does not remit as acute pain does, clients experiencing chronic pain commonly experience extensive medical treatments and procedures. Many clients feel frustrated when test results report no abnormalities or the medical procedures and treatments are not helpful in providing relief (Sperry, 2007). A lack of concrete diagnostic evidence does not mean an absence of pain or hypochondriasis. However, the client's frustration about the pain condition often results in a loss of empowerment and strength-based action.

Approximately 35% to 57% of the adult population in the United States reported experiencing chronic pain in the past year (Pain Medicine, 2005; Pizzi et al., 2005; Turk & Burwinkle, 2005), which costs society more than $70 to $100 billion annually in direct health-care costs and lost productivity (Holmes et al., 2006; Libby, 2006; Pain Medicine, 2005). In addition to monetary losses, the client's suffering can include divorce, alcoholism, drug abuse, family violence, absenteeism, job loss, depression, and suicide (Renshaw, 2007). Most clients experiencing chronic pain seek treatment exclusively from physicians. In one study, 30% of clients were uncertain of the cause of their pain, 42% believed that pain medication gave the most effective pain relief, 24% believed nothing relieved their pain, and 48% had taken medication for a mood disorder occurring after pain onset (Browne, Schug, Ray, & French, 2006). Because chronic pain often defies medical explanation, the pain and suffering experienced by the client is often conceptualized as something that must be stopped and never experienced again (Renshaw, 2007), which results in clients easily becoming consumed with monitoring and controlling the pain.

With the high prevalence rate of chronic pain in the adult population, it is important for counselors to understand effective counseling treatments to augment traditional medical care (Guterman & Rudes, 2005). In this article, I discuss the role of counseling and its impact on chronic pain, counseling in medical model settings, treatment interventions, treatment planning, cultural considerations, and ethical and legal concerns for counselors treating clients experiencing chronic pain.

* Counseling and Chronic Pain

Karlin et al. (2005) reported on extensive research confirming the considerable role psychological factors play in the experience and expression of chronic pain. For example, during periods of developmental instability, stress is harder to resolve and creates a greater chance of having an impact on the client's physiology (Blakeney & Blakeney, 1992). Building on those findings, research has also consistently demonstrated that any type of counseling was more effective than a wait-list control for all measurement domains (including pain expression and activity level) for clients experiencing chronic pain (Kerns, Thorn, & Dixon, 2006). High levels of psychological distress (particularly depression and anxiety), functional disability, maladaptive cognitions, and poor coping strategies are commonly exhibited by clients (Karlin et al., 2005). These psychological factors not only contribute to and exacerbate pain, they often significantly affect the success of any form of medical treatment or intervention. When clients experiencing chronic pain make the connection between psychological stress and physiological response, the client gains the opportunity to improve the chronic pain condition (Blakeney & Blakeney, 1992). …

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