Chronic pain: what it is and how it is treated from Psychology
The chronic pain, one whose duration exceeds six months, is an experience not only different from acute pain in a quantitative way, but also, and above all, qualitatively. How can you deal with it? To find out, you first need to explore what pain is.
How does pain work?
The idea that the feeling of pain depends only 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 about the pain of the Ghost member? 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 distraction?
Melzack and Wall proposed in 1965 the Control Gate Theory, which maintains that pain is composed of three dimensions:
- Sensory or Discriminatory: refers to physical properties of pain.
- Motivational or Affective: referred to emotional aspects of it.
- Cognitive or Evaluative: relative to the interpretation of pain based on attentional aspects, previous experiences, the sociocultural context ...
What influence do these factors have? The perception of noxious 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, the arrival of a "hurts" is necessary. brain. However, does the brain always receive this information?
The pain valve
According to the authors, there is a gate that allows (or not) the entry of this information to the neural pathway, depending on whether it opens or closes. It is the previously mentioned dimensions, the physical, emotional and cognitive factors, which 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, in the long term, could modify the excitability thresholds, thus increasing sensitivity to it.
Currently, it makes no sense to speak of psychogenic pain and organic pain. Simply, in humans, pain is always influenced by psychological factors, which means that in his experimentation he not only goes from 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 are:
- Attention distraction.
- Self-affirmations: tell yourself that you can cope with pain without great difficulty.
- Ignore the sensations of pain.
- Increase your activity level: through the use of distracting behaviors.
- Search for support Social.
Different scientific studies have tried to find out which of them are truly effective. However, the results are not conclusive, except for what is known about a bad strategy: catastrophism.
What is catastrophism?
Catastrophism is defined as the set of very negative thoughts that pain has no end, no 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 assessment of catastrophism. These allude to the inability to remove pain from the patient's mind (rumination), the exaggeration of the properties threatening pain stimulus (magnification) and the feeling of inability to influence pain (helplessness). The results suggest that rumination is more consistently related to this strategy.
The pain scheme
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 catastrophic scheme, which consequently biases the cognitive and emotional processing of the person, contributing, again, to the persistence from pain. In this way, a vicious circle is entered. How to get out of it?
Psychology intervention in chronic pain
Targeting the elimination of chronic pain can be not only ineffective, but also detrimental for the patient, as well as an intervention aimed at promoting positive thoughts and emotions by respect. As an alternative, the role of acceptance and Contextual Therapy in chronic pain.
The role of acceptance
Acceptance consists of the selective application of control to that which is controllable (to Unlike resignation, which tries to substitute control for the absence of formal control. absolute). From this point of view, psychological interventions offer patients strategies 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 with 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. Is consists of changing the function of the patient's emotions and thoughts (do not modify them themselves). In this way, it is intended that patients experience that emotions and thoughts happen to them, but not are the cause of their behavior, coming to consider in this way what are the values that act as the engine of the herself.
With regard to pain, try to assume its presence without trying to suppress it, engaging in other life activities oriented to different objectives.
Bibliographic references:
- Fernández Berrocal, P., & Ramos Díaz, N. (2002). Smart hearts. Barcelona: Kairos.
