is a Pain Disorder?
any painful condition, psychological factors are involved, in that
the pain will feel more or less intense, or be more or less bearable,
depending on the person’s emotional state and whether or not
they have anything to distract their mind from the pain. This is
a normal reaction, although the extent to which psychological factors
impact upon the experience of pain varies considerably. Some people
experience pain which is much more intense or more prolonged than
can be explained by physical illness or injury alone, and where
it is clear that psychological factors are playing a much more significant
role in the person’s experience of pain. However, it is very
important to understand that, whatever the causes of pain, the person
feels the pain in the same way, i.e. it actually hurts and is real.
people have a tendency to “somatise” emotions, and,
instead of feeling depressed or stressed, which may be too difficult
for them to accept, they may experience pain in a part of their
body. They are essentially expressing emotional distress as physical
pain. It is not uncommon for some people who are suffering from
Depression go to their doctor complaining about a range of physical
symptoms rather than depressed mood.
nature and role of psychological factors varies. In some cases there
may be a psychological overlay to a basically physical pain problem,
in that the person perhaps unnecessarily avoids activities, because
of an excessive fear of hurting themselves. Others may adopt, or
be encouraged by others, to adopt a “sick role” and
are more dependent on others for help in daily activities than necessary.
Disorder is a psychiatric condition which recognises the impact
of significant psychological factors on the experience of chronic
pain. It is also commonly referred to as Chronic Pain Syndrome.
are the symptoms?
person mainly complains of pain, which medical specialists cannot
explain in terms of physical causes alone. For example, the pain
may be felt in an unusual pattern in the body, or it may be more
severe or prolonged that would normally be expected given the nature
and severity of an injury, or it may obviously fluctuate with mood.
In very severe cases, where for example a severe Pain Disorder has
been formally diagnosed, the person’s whole life, and often
also that of their family, seems to revolve round their pain, with
marked avoidance of normal activities, excessive use of analgesic
medication, and undue reliance on others for assistance.
long does it last?
cases where there is a mild psychological overlay to pain, or where
there is some degree of somatisation, the problem may resolve naturally
once a period of stress is over. Where both physical and psychological
factors are involved to an equal degree, then physical recovery
will normally be accompanied by improvement in the person’s
mental health. However, some people with severe Pain Disorders,
if untreated, may not recover.
is the treatment?
many people suffering from chronic pain conditions, CBT has been
found effective through a process of challenging negative thoughts
about pain, and increasing levels of activity, and assisting people
to live more adaptively with the pain. There can, however, be difficulties
in engaging the client in the therapy, as many people resist the
suggestion that psychological factors are involved, believing that
people think the pain is only “in their mind”. Reassurance
that the therapist believes that the pain is genuinely felt is essential,
and working towards a shared understanding of how the pain interrelates
with emotions is a necessary preliminary stage in therapy.
severe and chronic cases of Pain Disorder require an intensive multidisciplinary
pain management programme, with involvement of Doctors, Psychologists
or other CBT Therapists, and Physiotherapists. Such programmes are
normally provided on an in-patient or day-patient basis. The treatment
results for more severe and chronic Pain Disorders are very variable,
although some people do gain great benefit from this approach.