Chronic pain: what is it and how it is treated by psychology

the chronic painThis duration exceeds six months, is an experience not only different from acute pain quantitatively, but also, and above all, qualitatively. How to cope? To find out, you must first explore what pain is.

How does pain work?

The idea that the sensation of pain depends only on the physical damage produced (simple linear model) has been maintained for a long time. However, this way of understanding pain is considered insufficient to explain certain clinical phenomena.

What about phantom limb pain? And with the placebo effect? Why does it seem like the pain intensifies when we are silent, in the darkness of the night, when we are in bed without any distractions?

Melzack and Wall proposed in 1965 the Control gate theory, Which argues that pain is made up of three dimensions:

  • Sensory or discriminatory: Refers to the physical properties of pain.
  • Motivating or emotional: Refers to its emotional aspects.
  • Cognitive or evaluative: Relating to the interpretation of pain according to attentional aspects, previous experiences, socio-cultural context …

What influence do these factors have? The perception of harmful stimuli is not direct, but there is a modulation of the message at the level of the spinal cord. This implies that in order to feel pain, an “evil” must arrive in the brain. However, does the brain always receive this information?

The Pain Valve

According to the authors, there is a gate that allows (or does not allow) the entry of this information into the neural pathway, Depending on whether it opens or closes. These are the previously mentioned dimensions, the physical, emotional and cognitive factors, which control its opening or closing.

Over the past decade, Melzack has proposed a Neural network model which postulates that although the treatment of pain is genetically determined, it can be altered by experience. Thus, factors that increase the sensory flow of long-term pain signals could alter thresholds for excitability, thereby increasing sensitivity to it.

Currently, it makes no sense to talk about psychogenic pain and organic pain. Simply, in humans, pain is always influenced by psychological factors, Which means that in his his experimentation goes not only pain receptors to the brain, but also in the opposite direction.

Strategies for coping with chronic pain

What strategies do patients with chronic pain use to try to resolve?

These include:

  • Distracted attention.
  • self-affirmations: Tell yourself that you can handle the pain without too much difficulty.
  • Ignore the sensations of pain.
  • Increase your activity level: Through the use of distracting behaviors.
  • Find support social.

Different scientific studies have tried to find out which of them are really effective. However, the results are inconclusive, except for what is known about a bad strategy: catastrophism.

What is catastrophism?

Catastrophism is defined as the set of very negative thoughts referring to the fact that pain has no end, no solutionNothing can be done to improve it either.

The work done at Dalhousie University in Halifax by Sullivan and his team distinguishes three dimensions in the assessment of catastrophism. These refer to the inability to remove pain (rumination) from the patient’s mind, exaggeration of the threatening properties of the pain stimulus (magnification), and the feeling of inability to influence pain (impotence) .). The results suggest that rumination is more systematically linked to this strategy.

The Pain Diagram

Pain, as an unpleasant emotion, is associated with unpleasant feelings and thoughts. In order to try to improve their quality of life, people try to suppress them. However, not only do they not get it, but they also cause it to get stronger (producing the rumination that will keep them active all the time).

This activation is in turn associated with other negative emotions, which reinforces the catastrophic pattern, which therefore skews the person’s cognitive and emotional processing, again contributing to the persistence of pain. In this way, we enter a vicious circle. How to get out of it?

Intervention of psychology in chronic pain

Setting the goal of eliminating chronic pain can be not only ineffective, but also detrimental to the patient, as can an intervention to promote positive thoughts and emotions in this regard. Alternatively, the role of acceptance and Contextual therapy in chronic pain.

The role of acceptance

Acceptance is the selective application of control to what is controllable (unlike resignation, which seeks to replace control with the absence of absolute control). From this point of view, psychological interventions offer patients strategies to improve their quality of life in a painful life, without seeking to eliminate it.

Although there is still little research in this direction, a study conducted at the University of Chicago shows that people with greater pain acceptance show lower values ​​of anxiety and depression, In addition to a higher level of activity and employment status.

Contextual therapy

Contextual therapy or acceptance and engagement therapy, developed by Hayes and Wilson, has so far been poorly applied to chronic pain. this one it consists of changing the function of the patient’s emotions and thoughts (Do not modify them themselves). In this way, we try that the patients feel that the emotions and the thoughts come to them, but they are not the cause of their behavior, getting to consider in this way which are the values ​​that act as the motor of the same.

As for pain, it tries to assume its presence without trying to suppress it, engaging in other vital activities with different goals.

Bibliographical references:

  • Fernández Berrocal, P. and Ramos Díaz, N. (2002). Smart hearts. Barcelona: Kairós.

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