Chronic pain as a lifestyle

Czech version

Authors: P. Knotek
Authors‘ workplace: Oddělení klinické psychologie, Centrum pro léčení a výzkum bolestivých stavů, FN Motol, Praha
Published in: Reviz. posud. Lék., 10, 2007, č. 3, s. 67-74

Overview

Pain is the most frekvent symptom of diseases and the most common cause of a medical consultation. The acute pain roughly corresponds to pathophysiological conditions. The chronic pain implies only low dependent relations between pathophysiological conditions, psychological changes, and behavior. This article discusses psychological responses to pain, and consecutive changes of Self-assessment, behavior, and social integration, independent on pathophysiological conditions. The repeatedly tested model describes these processes (Fig. 1): Pain arises in the context of already existing pain beliefs and attitudes. The pain beliefs and pain start focusing of attention and fear of pain. If withdrawal and resignation consecutively develop, than anxiety, anger and depression grow. These affects elicit changes of Self-perception and learned pain behavior. The learned pain behavior is relatively independent on pain, and is developed and stabilized by different advantages, financial supports and other secondary gains. The patient behavior elicits reactions of other people, who support or inhibit the pain behavior. The secondary gains of other people are frequent too (see the ill grandmother, who keeps her daughter’s house and takes care of her grandchildren). The first stage of the psychological changes in a patient is characterized by the predominance of affective quality over sensory quality of pain (the first affective stage). The second affective stage is characterized by general negative affects, anxiety, anger, and depression. The final phase of the psychological changes is the learned pain behavior. The person accepts the role of a patient and the therapy becomes a mere ritual, because the recovery and the loss of the status of ill person is a threat of its life style.

Key words:
chronic pain – cognitions – affects – pain behavior – social adaptation and maladaption

Sources

1. Arnstein, P., Claudill, M., Wells-Federman, C. Self-Efficacy as a Mediator of Depression and Disability in Chronic Pain. In Devor, M., Rowbotham, M. C., Weisenfeld-Hallin, Z. Proceedings of the 9th World Comgress on Pain. IASP Press : Seattle 2000, p. 1105–1111.

2. Banks, W. A., Watkins, L. R. Mediation of chronic pain: not by neuron alone. Pain, 2006, 124, p. 1–2.

3. Bartholomew, K., Horowitz, L. M. Attachment styles among young adults: a test of four-category model. J. Pers. Soc. Psychol., 1991, 61, p. 224–244.

4. Craigh, K. D. Social modeling influences: pain in context. In: Sternbach, R. A. (Eds.) The Psychology of Pain. New York : Raven Press 1986, p. 67–95.

5. Crombenz, C., Merley, S., McCracken, L., Sensky, T., Puncus, T. Self, Identity, and Acceptance in Chronic Pain. In: Dostrovsky, J. O., Carr, D. B., Koltzenburg, M. (Eds.) Proceedings of the 10th World Congress on Pain. Progress in Pain Research and Management, Vol. 24. IASP Press : Seattle 2003, p. 651–659.

6. Gamsa, A. Is emotional disturbance a precipitator or a consequence of chronic pain? Pain, 1990, 42, p. 183–195.

7. Gatchel, J. R. Psychological disorders and chronic pain: cause-and effect relationships. In Gatchel, J. R., Turk, D. C. (Eds.) Psychological Approaches to Pain Management: A Practitioner’s Handbook. New York : Guilford Press 1996, p. 30–51.

8. Fordyce, W. E. Behavioral Methods in Chronic Pain and Illnes. St. Louis : Mosby 1976.

9. Huskisson, E. C. Measurement of pain. Lancet, 1974, 2, p. 1127–1131.

10. Keefe, F. J., Dunsmore, J. Pain behavior. APS Journal, 1992, 1, p. 92–100.

11. Knotek, P. Bolest jako klamná informace. Čs. Psychol., 1999, 43, s. 40–51.

12. Knotek, P. Fear of chronic pain: intervening process between pain, pain beliefs and chanege of affects? In Roussi P., Vassilaki E., Kaniasty K. Baker J. (Eds.) Elektronic Proccedings of 27th STAR Society Conference, 13-15 July 2006, Univ. of Crete, Rethymnon 2006, p. 180-188.

13. Knotek, P., Knotková, H. Psychologické problémy chronické bolesti. Čs. Psychol., 1998, 42, s. 63–74.

14. Knotek, P., Knotková, H. Suffering and chronic pain: New view on old paradigm. Stud. Psychol., 1998, 40, 1, s. 65–172.

15. Knotek, P., Knotkova, H. Fear and Observation of Pain Inventory (FOPI): a new method for an evaluation of disturbances in adaptation to chronic pain. (Abstract). 28th Stress and Anxiety Research Society Conference. July, Bavaro, Dominican Republic: STAR, 2007.

16. Knotek, P., Williams, D. A., Blahuš, P., Žalský, M. Dotazník názorů na bolest a percepce bolesti: česká verze. Bolest, 2001, 3, s. 149–155.

17. Lazarus, R. S., Folkman, S. Stress, Apptaisal, and Coping. New York : Springer 1984.

18. McWilliams, L. A., Amundsen, G. J. G. The relationship of adult attachment dimensions to pain-related fear, hypervigilance, and catastrophizing. Pain, 2007, 127, p. 27–34.

19. Melzack, R., Casey, K. L. Sensory, motivational, and central control of determinants of pain. In Kenshao, D. R. (Ed.) The Skin Senses. Springfield, IL : Charles C. Thomas 1968, p. 423–439.

20. Miller, C., Cronan, T. The effects of coping style and Self-efficaca on health status care costs. Anxiety, Stress, and Coping, 1998, 11, p. 311–325.

21. Neradilek, F. Bolest jako syndrom. In Rokyta, R., Kršiak, M., Kozák, J. Bolest. Praha : Tigis 2006, s. 22–26.

22. Price, D. D. Psychological mechanism of pain and analgesia. Seattle, WA : IASP Press, 1999.

23. Price, D. D., Harkins, S. W. The affective-motivational dimension of pain: a two stage model. American Pain Society Journal, 1992, 1, p. 229–239.

24. Price, D. D. Psychological Mechanism of Pain and Analgesia. Progress in Pain Research and Management, Vol. 15. Seattle : IASP Press, 1999.

25. Reber, A. S. Dictionary of Psychology. Middlesex : Harmondsworth 1985.

26. Riley, J. L., Wade, J. B. Psychological and demographic factors that modulate the different stages and dimensions of pain. In Price, D. D. Psychological Methods of Pain Control: Basic Science and Clinical Perspectives. Progress in Pain Research and Management, Vol. 29, Seattle : IASP Press, p. 19–41.

27. Schwartz, L., Slater, M. A., Birchler, G. R. Interperonal stress and pain behaviors in patients with chronic pain. J. Consult. Clin. Psychol., 1994, 62, p. 861–864.

28. Smith, B. H., Elliot, A. M., Hannaford, P. C. Is chronic pain a distinct diagnosis in primary care? Fam. Pract., 2004, 21, p. 66–74.

29. Smith, B. H., Macfarlane, G. J., Torrance, N. Epidemiology of chronic pain, from the laboratory to the bus stop: time to add understanding of biological mechanism to the study of risk factortors in population-based research? Pain, 2007, 127, p. 5–10.

30. Spielberger, C. D., Reheiser, E. C. Measuring anxiety, anger, depression, and curiosity as emotional states and personality traits with the STAI, STAXI, and STPI. In Hersen, M., Hilsenroth, M. J., Segal, D. L. (Eds.) Comprehensive Handbook of Psychological Assessment, Vol. 2, Personality Assessment. Hoboken, N. J. : John Willey & Sons, Inc. 2003, p. 70–86.

31. Sullivan, M. J., Thorn, B., Haythornthwaite Theoretical perspectives on the relation between catastrophising and pain. Clinical Journal of Pain, 2001, 17, p. 52–64.

32. Wade, J. L., Dougherty, L. M., Archer, C. R., Price, D. D. Assessing of the stages of pain processing: a multivariate analytical approach. Pain, 1996, 86, p. 157–167.

33. Williams, D. A., Thorn, B. E. An empirical assessment of pain beliefs. Pain, 1989, 36, p. 351–385.

34. Zavadilová, R., Knotek, P. Dotazník sociálního copingu chronické bolesti. Bolest, 2006, 9, s. 100–104.

35. Žalský, M., Knotek, P. Bolest, názory na bolest, afekty a stres v rodině: rozdíly mezi psychickými poruchami. Bolest, 2003, 6, s. 233–240.

Labels

Medical assessment Occupational medicine

Colorectal carcinoma in Assessment Medicine

Vertebral and myofascial diseases and their contribution to a temporary working disability and consequently on invalidism

Article was published in

Medical Revision

2007 Issue 3