Chronic pain , which lasts more than six months, is an experience that is not only different from acute pain in quantitative terms, but also, and above all, in qualitative terms. How can it be dealt with? To know this, it is first necessary to explore what pain is.
How does pain work?
The idea that the feeling of pain depends solely on the physical damage produced (simple linear model) has been maintained over 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 phantom limb? What about the placebo effect? Why does the pain seem to intensify when we are silent, in the dark of night, when we are in bed without any distraction?
Melzack and Wall proposed in 1965 the Control Gate Theory , which holds that pain is composed of three dimensions:
- Sensory or Discriminative : refers to physical properties of pain.
- Motivational or Affective : referring to emotional aspects of it.
- Cognitive or evaluative : related to the interpretation of pain in terms of attentional aspects, previous experiences, the 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 it is necessary for a “pain” to reach the 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 is opened or closed. 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, in the long term, modify the thresholds of excitability, thus increasing sensitivity to pain.
Actually, it doesn’t make sense to talk about psychogenic pain and organic pain. Simply, in humans, 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 dealing with chronic pain
What strategies do patients with chronic pain use to try to cope?
Among them, the following stand out:
- Distraction of attention .
- Self-affirmations : telling oneself that one can face pain without great difficulty.
- Ignore the sensations of pain.
- Increase your activity level : by using distracting behaviour.
- Seeking 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 one 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 solution , nor can anything be done to improve it.
The work done at Dalhousie University in Halifax by Sullivan and his team distinguishes three dimensions in assessing catastrophism. These refer to the inability to take 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 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 fail to do so, but they also make them stronger (producing the rumination that will keep them active on an ongoing basis).
This activation is, in turn, associated with other negative emotions, which strengthens the catastrophic scheme, which consequently skews the cognitive and emotional processes of the person, contributing, again, to the persistence of pain. In this way, a vicious circle is entered. How to get out of it?
Psychological intervention in chronic pain
Targeting the elimination of 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. As an alternative, the role of acceptance and Context Therapy l in chronic pain is studied.
The role of acceptance
Acceptance is the selective application of control to that which is controllable (as opposed to resignation, which seeks to replace control with no control at all). 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 area, a study carried out at the University of Chicago shows that people who are more accepting of pain show lower values of anxiety and depression , as well as a higher level of activity and work status.
Contextual Therapy or Acceptance and Commitment Therapy, developed by Hayes and Wilson, has so far been applied sparingly to chronic pain. It consists of changing the function of the patient’s emotions and thoughts (not modifying them themselves). In this way, it is attempted that the patients experience that the emotions and thoughts happen to them, but they are not the cause of their behaviour, thus coming to ask themselves what values act as the motor of their behaviour.
With respect to pain, he tries to assume its presence without trying to suppress it, involving himself in other vital activities oriented to different objectives.
- Fernández Berrocal, P., & Ramos Díaz, N. (2002). Intelligent hearts. Barcelona: Kairós.