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The Different Angles of Pain Treating Pain in Body, Mind and Soul Hope and Hopelessness Work-Related Learning for Acute Pain Art and Chronic Pain

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The Different Angles of Pain Treating Pain in Body, Mind and Soul Hope and Hopelessness Work-Related Learning for Acute Pain Art and Chronic Pain s u m m e r 2 0 1 1 pain news a publication of the british pain society Health on Net Unrelieved pain is a global problem National In-Patient Pain Survey (NIPPS) The standardisation of care? The different angles of pain Treating pain in body, mind and soul Hope and hopelessness Work-related learning for acute pain Art and chronic pain an alliance of professionals advancing the understanding and management of pain for the benefit of patients PROFESSIONAL PERSPECTIVES developing chronic physical health problems (Gatchel, Peng, Peters, The different angles of pain Fuchs & Turk, 2007; NICE, 2009). In addition, emotional responses such as anxiety, fear, depression and anger can increase pain levels whereas better mood and happier mental states can assist in reducing them (Gatchel et al., 2007 provide an extensive overview of this concept; NICE, 2009). This emphasises the mind/ body connection and how a physical condition can influence a psychological one, and vice- dr cheryL rezeK The importance of this perspective due to previous experiences then versa. Inconsistent consideration ConSultant CliniCal PSyChologiSt is that it views an individual as this may prevent the person from is sometimes given to the [email protected] being a combination of strands engaging in physical interventions psychological effects of pain and www.CherylrezeK.CoM that are specific to that person. that could impact on recovery or patients are not routinely asked One person may have a high pain management. This in turn about symptoms that may be No matter which way one looks at threshold for pain, a helpful family may influence the person’s ability pertinent to emotional distress it, pain hurts. One way of viewing set up but poor mobility and is to return to work, social or sexual (such as depression, anxiety, stress it is from a biopsychosocial easily frustrated. Another may relationships, financial stability or even anger and hopelessness). perspective i.e. from a biological, have a high pain threshold but and mood as well as increase Few questions are asked regarding psychological and social have few social support systems the likelihood of, say, isolation, the impact of chronic pain on perspective. Such an approach and be more vulnerable to depression or anger. The example relationships, whether sexual, looks to see how all three aspects feelings of distress. can have numerous variations and familial or social, substance misuse may be influencing the experience consequences, but the issue at or traumatic stress symptoms, of pain, its maintenance and The biospsychosocial model is a hand is that the person’s quality of and those referring to emotional its management. Biological and conceptual one that advocates a life may be adversely affected. or physical neglect or abuse of physiological factors such as shift when viewing pain from a any kind are frequently avoided hereditary conditions, nerve singular biomedical perspective The NICE guidelines (National altogether. Considering how pain damage and physical illnesses is to a more inclusive one. It was Institute of Clinical Excellence can impinge on all areas of one’s one area. The other is to consider initially given attention by George [NICE], 2009) recently life it seems limiting to view it the familial and social attitudes Engel in 1977 and the emphasis recommended screening for from the physical angle alone. to illness and pain, such as the is not on which of the three depression amongst patients with belief that we should seldom factors has greater importance chronic physical health conditions If we can bring together the experience pain, pain is part of or significance (although they due to their impact on mental divide and view ourselves as aging or that those in pain should should be rated according to the health and wellbeing. People with mind and body, rather than simply accept their lot and suffer condition and situation) but rather chronic conditions are estimated mind or body, then we can in silence. The third piece of this that all three should be taken to be two or three times more respect the idea that people perspective refers to our individual into account as influencing or likely to be depressed than those work as one system of integrated personalities and psychological maintaining the condition. It does who do not have such conditions. mechanisms. An illustration is the structure. not prescribe a blanket cause-and- Many chronic conditions produce impact psychological stress has effect relationship or promote the pain, such as cancer, multiple on the physical body. Our bodies We are moving on from whether idea that one automatically leads sclerosis, rheumatoid arthritis, are geared towards survival so something is either in the mind or to any other. Its aim is to view fibromyalgia and the interaction of when we are stressed it leads the body to a more cohesive view the condition within the context pain and depression can increase to the secretion of cortisol (and of mind and body. That in no way of the person and not only as a both morbidity and mortality adrenaline) which prepares implies that the pain one feels in medical condition with associated (NICE, 2009). the body for the fight or flight one’s body simply comes from the symptoms. response because it assumes we mind but what it does suggests These guidelines are a product of are in some form of danger. When is that the one can influence the By acknowledging and addressing the growing body of evidence that our bodies perceive danger (so other. In addition, it allows for the condition from all angles, supports the move towards both it doesn’t have to be real) then how our psychological structures it can provide opportunities for a biopsychosocial view of pain the rest of the system shuts down and personalities as well as our barriers to be eased and facilitating and pain management and how, in order for us to be able to run social and familial environments factors to be encouraged and for example, pain can increase or fight. However, if cortisol is and attitudes can impact on our enhanced. For example, if a the risk of depression as well as secreted when such a state is not wellbeing (Rezek, 2010). person has a poor body image or depression (and other emotional required but is due to the likes feels shame about his or her body factors) being a risk factor in of psychological stress, anxiety or 30 PAI N N E WS SUMMER 2011 pain, then there is too much or have developed sufficient coping All interventions are important but divisory one that splits people into too little of it in our systems as it mechanisms or had ongoing life perhaps at the heart of it is how camps that can only accommodate is out of its regular/normal cycle experiences upon which to draw these are combined. A cohesive a mind or body view. The aim of secretion. Stress, particularly due to their age. However, adults and boundaried mix allows is to encourage an openness to severe or chronic stress, weakens too don’t automatically have the people to feel safe and cared the extent to which our physical the immune system, slows down skills to manage such life-changing for, from all angles. It is when and emotional mechanisms are healing and the ability of the and enveloping alterations in their discreet interventions are provided entwined and to question the body to repair itself, strains the lives. It becomes apparent how by disparate professionals that once rigid and inflexible precepts heart, damages memory cells in much distress people attempt necessary and sometimes essential of the physical and emotional the brain and deposits fat at the to hide and how their long- factors can be lost. It’s the being entirely separate units. An waist rather than the hips and established means of dealing with difference between being provided emphasis has been placed on buttocks (which can increase the issues tend to be more entrenched with separate items of eggs, flour, psychological factors which is not risk factor for heart disease and under stress. Alternatively, their sugar and butter as opposed to a only due to my professional bias cancer). It is implicated in IBS, coping mechanisms for past homemade cake made from those but because it is an area that is aging, depression, chronic heart matters may not be sufficiently same ingredients. often complex and difficult to disease, hypertension, rheumatoid robust or inclusive to allow them understand. arthritis, diabetes and many other to deal with such a disruptive, Chronic conditions can shift and conditions (Gardner-Nix, 2009). chronic or intense situation and so change over time, and whereas a Pain, like people, is complex they look for other means, some psychological issue may have less and multidimensional and this The ripple effect scenario of which may not necessarily be in impact at one time it may increase perspective is only one offering. regarding poor body image, or their best interests. further down the line. What we The desire is to provide an opinion even stress for that matter, is think and feel (emotionally) that may benefit our approach to not an uncommon one seen in Personality factors may well will impact on what we feel pain and that may influence not clinical practice, albeit in multiple influence how one deals with pain. physically. It’s about learning to only the quality of care we provide forms. The implications of chronic They affect everything else in our manage the pain with one’s own but also our attitude towards those conditions can be far-reaching lives so it is inevitable that they internal resources and resilience, who may be suffering in ways of and pervasive.
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