Transition From Acute To Chronic Pain Anxiety To Depression

The laboratory findings of a one-to-one correlation between the intensity of short-lasting, noxious stimulation and reported pain do not hold true for chronic pain. With most chronic pain patients, the intensity of the pain is not correlated with the intensity of the wound or lesion. The psychological or emotional significance of the pain may be the primary determinant of its perceived intensity.

Even acute pain is not a simple matter of stimulus intensity in the clinical situation. Beecher (1946, 1959) observed, on the Anzio beachhead during World War II, that wounded soldiers did not typically report pain as they waited to be removed from the battlefield, in spite of gunshot and shrapnel wounds that eventually may have needed major surgery, amputation, and long-term convalescence. He contrasted the wounded soldier's mild euphoria with similarly injured civilians in a hospital emergency setting, who typically expressed considerable pain and suffering. The soldier knew he was going home, and that he no longer had to fear being killed: for the civilian the pain has socio-economic implications, fear of job loss, and so on. Subsequent studies have confirmed that acute pain is primarily mediated by anxiety (Sternbach, 1968). Beecher's (1959) emphasis on the manner in which the psychological significance of the pain modulates wound severity has led to the delineation of learning factors and early experience in the development of chronic pain behavior (Sternbach, 1968). A child, after falling, surveys the environs to establish whether a parent is nearby to provide tender loving care before deciding whether to cry or continue playing with his/her friends. Early learning patterns in the management of transient and acute pain may lead to enduring developmental patterns in which pain and suffering can become instrumental in manipulating the environment, for example, avoiding school, getting attention from Mommy, and so forth. Such factors are prevalent in the psychological history of chronic pain patients.

The management of acute pain (including some aspects of terminal cancer pain and chronic transient headaches; Evans, 1989) involves the direct management of anxiety. The growing anxiety about the short- and long-term consequences of an injury or illness which accompanies the increasing intensity of the noxious stimulation is usually relieved by adequate treatment such as pain medication, hypnosis, or any other intervention that reduces anxiety, facilitates relaxation and refocuses attention (Evans, 1990b, 2001).

When the pain is not relieved satisfactorily, a different set of dynamics develop. Although pain intensity may have increased initially, it tends to abate gradually. However, the fear of continued suffering remains. The anticipatory feelings of future fear give way to the frightening awareness that a painful injury or condition may have a permanent effect. Despair and despondency develop as the suffering remains partially unrelieved, and activities become restricted. The seductiveness of seeking, demanding, and receiving help from significant others, including doctors and family, the mildly pleasant and/or euphoric effects of medication, or the sedation and induced sleep which avoids pain, can produce a reinforcement contingency for which the pain is a sufficient, and eventually a necessary precursor. Feelings of helplessness lead to depression, guilt, and internalized anger concerning perceived loss of bodily parts or functions, and diminished self-control. Gradually, a time-protracted pattern is established involving helplessness and depression which reinforces pain behavior (Fordyce, 1976; Sternbach, 1968). Pain is sometimes positively reinforced by its pleasant consequences, and sometimes negative consequences are avoided by continued pain. Good things happen only when the patient has pain: ('My low back pain allows me to watch the Sunday football game instead of mowing the lawn'). Alternatively, pain is that which prevents bad things from happening: ('When I have my migraines, I can avoid my spouse's advances'; 'My unmanageable children go outside and play when I hurt'). Hypnotic strategies need to be developed which will not initially threaten the secondary gain issues that typically exist with the chronic pain patient. Hypnotic intervention based on anxiety reduction will only frustrate the patient and the therapist, and will usually be unsuccessful. While using hypnosis for pain control it is necessary to address simultaneously the depression and secondary gain as psychotherapeutic issues.

Using Hypnosis To Achieve Mental Mastery

Using Hypnosis To Achieve Mental Mastery

Hypnosis is a capital instrument for relaxation and alleviating stress. It helps calm down both the brain and body, giving a useful rest. All the same it can be rather costly to hire a clinical hypnotherapist, and we might not always want one around when we would like to destress.

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