Focusing Patients' Attention on Pain May Actually Worsen It. (A New Pain Paradigm)

By Celia, Frank | Clinical Psychiatry News, April 2002 | Go to article overview

Focusing Patients' Attention on Pain May Actually Worsen It. (A New Pain Paradigm)


Celia, Frank, Clinical Psychiatry News


PITTSBURGH -- Encouraging patients to focus too much attention on their sensory perceptions of pain can effect physiologic changes in neural signaling that actually increase levels of discomfort, Dr. Lonnie K. Zeltzer said at a meeting on managing pain in pediatric patients sponsored by the Western Psychiatric Institute.

If proven valid, the findings could change the way physicians treat chronic and recurring pain. For example, the common practice of requiring patients to keep diaries that document when their pain is most intense would be discontinued. It would be replaced instead with a "functional model" that asks youngsters to rate how pain affects their everyday activities, Dr. Zeltzer said at the meeting, which was also sponsored by the University of Pittsburgh and the Children's Hospital of Pittsburgh.

Neural pain signaling also can be directly influenced by levels of psychological arousal, memory, beliefs, emotions, and family life. Physicians need to deal with these factors more often, said Dr. Zeltzer, director of the pediatric pain program at Mattel Children's Hospital at the University of California, Los Angeles.

If psychological conditions were better controlled, physicians could make less use of invasive surgical and pharmacologic pain-killing techniques, she said.

The concept that guided earlier management of pain, specifically that pain is directly proportional to the nature and extent of an injury, is no longer tenable, said Dr. Linda J. Ewing of the departments of psychiatry and psychology at the Western Psychiatric Institute, Pittsburgh, and the meeting's director.

Researchers have long suspected that how a patient fixates on pain is associated with pain severity. A 1991 study of 60 children who had undergone minor elective surgery found that ruminating about the pain was associated with greater pain severity, as well as poorer physical recovery (J. Pediatr. Psychol. 16[5]:643-63, 1991).

But now there appears to be physiologic evidence to support the notion that pain is linked to psychology. The process of experiencing pain involves proinflammatory cytokines (PICs), proteins that signal the central nervous system to create a whole host of changes commonly referred to as the sickness response. …

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