Chronic Pain: What It Is And How It Is Treated From Psychology
He chronic pain which lasts more than six months, is an experience not only different from acute pain quantitatively, but also, and above all, qualitatively. How can you cope? To know, it is first necessary to explore what pain is.
The idea that the feeling of pain depends solely on the physical damage produced (simple linear model) has been maintained for a long period of time. However, this way of understanding pain is considered insufficient to explain some clinical phenomena.
What happens with phantom limb pain? And with the placebo effect? Why does the pain seem to intensify when we are silent, in the dark of the night, when we are in bed without any distractions?
Melzack and Wall proposed in 1965 the Control Gate Theory which maintains that pain is composed of three dimensions:
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 to feel pain, the arrival of a “hurts” to the brain is necessary. However, does the brain always receive this information?
The valve of pain
According to the authors, There is a gate that allows (or not) the entry of this information into the neural pathway. depending on whether it opens or closes. It is the previously mentioned dimensions, the physical, emotional and cognitive factors, that control its opening or closing.
In the last decade, Melzack has proposed a Neural Network Model which postulates that, although pain processing is genetically determined, it can be modified by experience. In this way, factors that increase the sensory flow of pain signals could modify excitability thresholds in the long term, thus increasing sensitivity to it.
Currently, it does not make sense to talk about psychogenic pain and organic pain. Simply put, in human beings, pain is always influenced by psychological factors which means that in its experimentation it not only goes from the 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 solve it?
Among them stand out:
Different scientific studies have tried to find out which of them are truly 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 or solution nor can anything be done to improve it.
The work carried out at Dalhousie University in Halifax by Sullivan and his team distinguishes three dimensions in the evaluation of catastrophizing. These refer to the inability to get the pain out of the patient’s mind (rumination), the exaggeration of the threatening properties of the painful stimulus (magnification) and the feeling of inability to influence the pain (helplessness). The results indicate that rumination is more consistently related to this strategy.
Pain, as an unpleasant emotion, is associated with unpleasant emotions and thoughts. To try to improve their quality of life, people try to suppress them. However, not only do they not succeed, but they also make them stronger (producing rumination that will keep them active continuously).
This activation is associated, in turn, with other negative emotions, which strengthens the catastrophizing schema, which consequently biases the person’s cognitive and emotional processing, contributing, again, to the persistence of pain. In this way, we enter a vicious circle. How to get out of it?
Psychology intervention in chronic pain
Setting the goal of eliminating chronic pain can be not only ineffective, but also harmful to the patient, as can an intervention aimed at promoting positive thoughts and emotions about it. Alternatively, the role of acceptance and Contextual Therapy in chronic pain.
The role of acceptance
Acceptance consists of the selective application of control to what is controllable (unlike resignation, which tries to replace control with the absolute absence of control). From this point of view, psychological interventions propose strategies to patients to improve their quality of life in a life with pain, without trying to eliminate it.
Although there is still little research in this line, a study carried out at the University of Chicago shows that People who have greater acceptance of pain show lower levels of anxiety and depression in addition to a higher level of activity and employment status.
Contextual Therapy
Contextual Therapy or Acceptance and Commitment Therapy, developed by Hayes and Wilson, has so far been rarely applied to chronic pain. This consists of changing the function of the patient’s emotions and thoughts (do not modify them themselves). In this way, we try to make patients experience that emotions and thoughts happen to them, but are not the cause of their behavior, thus leading to the question of which values ​​act as the driving force behind it.
With respect to pain, try to assume its presence without trying to suppress it, getting involved in other vital activities aimed at different objectives.
