Psychological Issues in Pain Management

It is quite common for people who have chronic pain to experience depression as a natural response to the oppressive impact of the limitations imposed by pain.  The relentless presence of pain often exhausts people trying heroically to cope.  Even those with the best dispositions prior to the onset of chronic pain may find themselves losing hope and sense of self worth.  The debilitation that chronic pain causes results in many losses…the loss of the freedom to perform activities previously performed with ease, loss of self esteem, loss of intimacy, loss of friends, loss of jobs and financial security, loss of comfort, loss of sleep and loss of recreational enjoyment.  There is a lot to grieve for.  Grief and depression need to be recognized and treated as part of a comprehensive treatment program for chronic pain.

If someone was already depressed or prone to depressive episodes prior to the onset of pain, the presence of chronic pain is fuel on the fire.  Professional care is often necessary to manage the profound mood changes that may occur with chronic pain.

It is common for chronic pain to generate anxiety in response to the uncertainties that attend these losses.  Many questions are often left unanswered or cannot yet be answered, leaving doubt and fear in its wake.  How will I manage my finances?  My relationships?  My health? How will I take care of myself if others can’t or won’t?  What can I do with my life with these limitations?  These questions and others can evoke the anxiety that makes suffering worse than it already was.  Anxiety must be recognized and treated as part of a comprehensive chronic pain program.

Sometimes, if someone has had physical trauma such as an auto accident, or has witnessed a terrifying event, one can develop a dissociative condition known as post-traumatic stress disorder. It is a psychological defense to the emotional trauma that attended the event.  This rather common but usually overlooked condition is characterized by hyper-vigilance, phobic avoidance of anything that reminds one of the trauma, psychic numbing, and spontaneous re-living of the event (flashbacks).  PTSD may be acute, appearing immediately after trauma, or may become chronic, becoming evident years after the trauma.  Sometimes the trauma has been forgotten and the immergence of symptoms, such as panic attacks and nightmares, are the only clues to the existence of PTSD.  There is a growing body of evidence that some chronic pain conditions are somatic manifestations of PTSD, especially when the medical evidence to account for chronic pain is weak.  There are now several effective methods for treating PTSD, both pharmacological and psychological.  If one has PTSD, its recognition and effective treatment may greatly reduce pain and suffering. Professional help from psychiatrists and psychotherapists trained in these methods may be imperative.