Lim, Vivian, Hong Kong Journal of Psychiatry
Chronic Pain (In the series: Advances in Psychotherapy, Evidence-Based Practice - Vol. 11) Beverly J. Field, Robert A Swarm Hogrefe, 2008 US$24.95; pp112; ISBN: 978-0-88937-320-4
In western countries, chronic pain prevalence estimates in the general population range from 10 to 55%. Approximately 70 million Americans report chronic pain, with 10% having pain for more than 100 days per year. Chronic pain imposes tremendous costs on patients, employers, and the health care system. The American Productivity Audit estimated that 13% of the work force lost productive work time due to common pain conditions including headache, back pain, arthritis, and other musculoskeletal conditions, from August 2001 to July 2002.
Chronic Pain, written by 2 academics from the departments of anaesthesiology and psychiatry at the Washington University School of Medicine, St Louis, provides up-to-date information for those of us who have been overlooked in the management of pain. In traditional attempts to look for pathology and to treat symptoms, the role of psychology is often underestimated. Any chronic pain is best treated with a patient-focused and integrated approach.
From a clinical perspective, it is useful to classify pain: acute or chronic, nociceptive or neuropathic. While acute pain is usually associated with tissue damage, chronic pain is a result of complex systems. It is better understood as the integration of biomedical and physiological processes. Psychological factors play an important role in sustaining pain perception and coping. Chronic pain leads to a vicious cycle of depression, helplessness, guilt, and increased preoccupation with pain. It is accompanied by a multitude of negative behavioural responses like restricted activity, sleep deprivation, and social withdrawal. Misuse of opioid analgesics and alcohol complicate patients' problematic behaviours. Patients with chronic pain often resist referral to mental health professionals. By the time they present to mental health services, many have already seen a number of physicians, some of whom may have implied that the pain is purely psychogenic. It can be challenging to establish a therapeutic alliance with patients who respond with defensiveness or hostility.
An overview and practice guides for the psychological evaluation of chronic pain are given in this book. The assessment should include: a careful review of the patient's medical records; exploration of the patient's beliefs, expectations, and negative cognitions related to pain; elicitation of symptoms of depression and anxiety; gauging of how well the patient and his / her family are adjusting to changes in family roles; elicitation of co-morbidities such as sleep disorders; and evaluation of the patient's coping skills. Because of the complexity and multidimensionality of pain, single-modality treatments are not as effective as multimodal approaches. Psychological therapy is rarely used as the sole treatment modality. It is usually combined with analgesic medications, behavioural or psychological therapies, physical therapies, injections, and interventional procedures. The goal of treatment, in most cases, is not to cure or 'fix' the pain, but to reduce the severity and improve function. The manner in which patients respond emotionally and behaviourally to pain varies, depending on individual characteristics and external resources. Individuals with broad coping-skill repertoires, flexible responses to adverse circumstances, and supportive families and friends may be able to make adaptive adjustments to living with pain. …