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Psychosocial Consequences of Chronic Pain - by Stacey L. Bourland, Ph.D.

There are a number of commonly experienced psychosocial consequences of chronic pain.  Symptoms of depression are very common among chronic pain sufferers, as are worry and anxiety.  Chronic pain often causes feelings of helplessness, anger, and frustration.  Difficulty sleeping is also very common, which, in addition to the pain itself, leads to irritability.  Many people with chronic pain no longer participate in their usual activities, including work, household chores, and social and recreational activities.  This decreased activity, along with irritability toward loved ones, often results in marital and family problems.  For example, if a spouse with chronic pain is no longer employed, the decreased household income can cause financial stress that can take a great toll on the marriage.  Decreased involvement in work and recreational activities can also leave the chronic pain sufferer socially isolated and lonely.

A significant advance in the treatment of chronic pain came in 1965 with the proposal of “Gate Control Theory” by Melzack and colleagues.  Gate Control Theory is an alternative to the traditional, medical model of pain.  According to the traditional model, pain is the result of nerve impulses traveling from the site of tissue damage in the body (for example, a broken bone or a patch of burned skin) to the brain.  According to this model, the amount of pain felt is proportional to the amount of tissue damage.  Gate Control Theory argues that this traditional model, while useful in some cases, is an oversimplification.  For example, research indicates that the actual correlation between tissue damage and perceived pain is surprisingly low.  The newer theory is called Gate Control Theory because Melzack and colleagues proposed that there is a “pain gate” within the spinal cord, which can either be open to allow pain signals to reach the brain or closed to block the pain signal.  According to the theory, not only do pain signals travel up the spinal cord from the body to the brain, but the brain also sends signals down the spinal cord to open or close the gate.

Because the correlation between tissue damage and pain is low, there must be other factors influencing how much pain is perceived.  According to Gate Control Theory, there are three sets of factors that open or close the pain gate:  physical, cognitive, and emotional factors.  Physical factors include not only tissue damage but also other factors such as muscle tension (which tends to open the gate) and pain medication (which can close the gate).  An example of a cognitive factor that can influence perceived pain is attention focus; focusing one’s attention on the pain tends to open the gate, whereas distracting attention away from the pain closes the gate.  With respect to emotional factors, the pain gate tends to be opened by negative emotions, such as anxiety, anger, and depression, and closed by positive emotions, such as happiness.

You may notice, then, that many of the psychosocial consequences of chronic pain are the very factors that make pain worse!  “Vicious cycles” often develop in the lives of chronic pain sufferers, such as between depression and pain, anxiety and pain, anger and pain, and boredom and pain.  Each of these factors - depression, anxiety, anger, and boredom - can be a result of pain and can also exacerbate pain.  Another vicious cycle that commonly develops is between pain and muscle tension.  A natural response to pain is to brace the muscles around the injured area, but the sensations of muscle tension are then interpreted by the brain as more pain.

The good news is that, because pain is influenced by so many factors, many avenues for pain management are available.  Pain can be reduced by factors such as relaxation, positive emotional states, and distracting one’s attention away from pain.  This is where psychologically based pain management can be helpful.  Pain management psychologists train patients in techniques such as muscle relaxation and visualization, in order to reduce muscle tension and anxiety and to distract attention away from pain.  Therapists also encourage patients to gradually increase their involvement in pleasurable, meaningful, and productive activities, in order to further distract attention away from pain and also to improve mood.  Group psychotherapy and support groups can also be very helpful, in order to reduce feelings of isolation and loneliness, and to allow group members to learn from one another’s experiences with pain management.  Therefore, I congratulate all of you who participate in P.U.R.E. H.O.P.E.!


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All information on the P.U.R.E. H.O.P.E. Web site is provided with the understanding that the P.U.R.E. H.O.P.E. does not engage in the practice of medicine.  The members of P.U.R.E. H.O.P.E. cannot and do not give medical advice.  No information on this Web site should be considered medical advice.  Only your personal physician can do this for you.

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