Field / Swarm Chronic Pain

1. Auflage 2008
ISBN: 978-1-61334-320-3
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 118 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

Although there are now proven behavioral and psychological methods of dealing with and alleviating chronic pain, methods that can supplement or replace drug treatments, these are not always applied in clinical practice. This volume in the series, Advances in Psychotherapy -- Evidence-Based Practice, provides psychological and medical therapists (and students) with practical and evidence-based guidance on diagnosis and treatment of chronic pain, and does so in a uniquely “reader-friendly” manner. The book is both a compact “how-to” reference, for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.
The most important feature of the book is that it is practical and “reader-friendly.” It has a similar structure to others in the series, and is a compact and easy-to-follow guide covering all aspects of practice that are relevant in real-life. Tables, boxed clinical “pearls,” and marginal notes assist orientation, while checklists for copying and summary boxes provide tools for use in daily practice.
Earn 5 CE credits for reading volumes of the Advances in Psychotherapy book series. Click here to find out more!

Autoren/Hrsg.

Field, Beverly J.

Swarm, Robert A.

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete AINS Schmerzmedizin & Schmerztherapie

Leseproben

1
Description of the Disorder
1.1   Definitions Pain is a complex, subjective experience with no objective tests or physiological markers Pain is a basic biological warning mechanism signaling tissue damage and physiological harm. It was described by Albert Schweitzer (1931, p. 62) as “…a more terrible Lord of mankind than even death itself.” In Paradise Lost, Milton (1910, p. 47) wrote that, “Pain is perfect misery, the worst of evils, and excessive, overturns all patience.” Webster’s dictionary (1983) defines pain as: (1) The sensations one feels when hurt mentally or physically, especially distress, suffering, great anxiety, anguish, grief, etc.: opposed to pleasure. (2) A sensation of hurting or strong discomfort in some part of the body. These descriptions and definitions speak to both the sensation of pain and to the suffering that accompanies it. The International Association for the Study of Pain Subcommittee on Taxonomy (Mersky, 1979) defined pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. This definition recognizes the complexity of pain, its sensory and emotional aspects, and its subjective nature. There are no reliable tests or consistent physiological markers of pain, and it is not always referable to any objective findings. To understand another person’s pain, it is necessary to rely on the subjective narration of his or her personal experience. The subjectivity of pain is acknowledged in the International Association for the Study of Pain (IASP) definition, as is the recognition of pain in the absence of tissue damage, which discounts previously held distinctions between somatogenic (or “real”) pain and psychogenic (or “imaginary”) pain. 1.2   Terminology It will be helpful to have a working knowledge of pain-related terminology and classifications. Some of the more common terms are listed below. A more comprehensive list of terms may be found in Merskey and Bogduk’s Classification of Chronic Pain (1994). Table 1 Terminology and Definitions Term Definition Allodynia Pain resulting from a stimulus that would normally not produce pain, such as a light touch or a breeze. Analgesia Absence of pain in response to stimulation that would normally be painful. Central pain Pain initiated or caused by a lesion or dysfunction in the spinal cord or brain. Hyperalgesia Increased sensitivity to a stimulus that is normally painful. Hypoalgesia Diminished sensitivity to a stimulus that is normally painful. Neuralgia Pain in the distribution of a nerve. Neuropathy A disturbance of function or pathological change in one or more nerves. Nociceptor A receptor preferentially receptive to a noxious stimulus. Noxious stimulus A stimulus that is damaging to normal tissue. Pain threshold The lowest stimulus intensity at which a person can recognize pain. Pain tolerance The greatest stimulus intensity causing pain that a person is prepared to tolerate. 1.2.1   Classification of Pain Pain may be classified along various dimensions, the most common of which are: •   Temporal (acute, chronic, and episodic) •   Mechanism of transmission (nociceptive, neuropathic, central) •   Disease state causing the pain (arthritis, diabetic neuropathy) •   Anatomical site (low back pain, neck or knee pain) Temporal Acute pain is one of the most frequent reasons for seeking medical care Acute pain is of brief duration, generally less than six months, and is usually associated with tissue damage. In the case of injury, acute pain is an adaptive and necessary biological signal of tissue damage and physiological harm. It serves to increase awareness and calls for an action or response such as withdrawing a limb from danger. In most cases of acute pain, the cause is known and adequate treatment is available. When healing is complete, the pain resolves. The initial emotional responses to acute pain, such as fear and anxiety, can serve to motivate care seeking and limitation of movement. Examples of acute pain include bony fractures, sprains, puncture wounds, childbirth, various acute disease states, and postsurgical pain. Chronic pain is now recognized as an independent disease state Chronic pain persists for an extended period of time. It is usually defined as pain lasting longer than six months or pain that persists beyond the expected time for healing. Unlike acute pain, the signal of chronic pain does not serve as a warning of further tissue damage and generally serves no adaptive purpose. The cause or causes of chronic pain may or may not be known in any given case. If the cause is known, it may or may not be amenable to a cure. Chronic pain interferes with normal functioning and daily living, and can be detrimental to overall health. It is often associated with loss of employment, inability to participate in recreational activities, financial distress, and changes in relationships, personal identity, and feelings of self-worth. Chronic pain is often referred to as chronic noncancer pain, in distinction from cancer pain, which may be caused by tumor invasion into tissue, obstruction of organs, compression or infiltration of nerves, painful procedures, or antitumor therapies such as radiation or chemotherapy. Figure 1 The Chronic Pain-Stress Cycle In the transition from acute to chronic pain, psychological factors play a changing and increasingly important role in pain perception and coping. Chronic pain is complex, and is associated with changes in physiological responses, dysphoric mood states such as depression, helplessness, guilt, and apathy, increased preoccupation with pain, and a general eroding of internal resources. In addition, chronic pain is accompanied by a multitude of behavioral responses including severely restricted activity, sleep deprivation, and social withdrawal. Examples of chronic noncancer pain include chronic low back pain, postherpetic neuralgia after shingles, osteoarthritis, and fibromyalgia. Recurrent, intermittent, or episodic pain is acute, in that each episode is of limited duration, but also chronic in that the episodes occur over a period of time lasting longer than six months. Although persons with episodic pain do not suffer from pain continuously, repeated episodes of pain may disrupt normal functioning at school, work and/or in personal relationships. Examples of episodic pain include migraine headache and sickle cell crises. Throughout this manual, references to pain will mean chronic noncancer pain unless otherwise noted. Although acute, cancer, and episodic pain present their own unique challenges, it is the extended time frame of chronic pain that brings about the life changes and emotional responses that result in its complexity and resistance to management. Neurophysiology of Pain Signal Transmission Signal transmission from injury does not result in pain until the information reaches the brain Nociception is the process of detection and transmission of pain signals from the site of injury to the central nervous system (CNS). The details of how nerve signals are transmitted, and ultimately perceived as pain, are not fully understood, although several processes are known to underlie nociception. In the process of transduction, energy from a noxious stimulus (thermal, mechanical, or chemical) is converted into nerve impulses by receptors called nociceptors. These nerve impulses, or pain signals, are then transmitted from the site of injury to the spinal cord and brain. The signals or nerve impulses are perceived as pain after reaching the brain. Pain signal transmission is continuously modulated by factors that either facilitate or inhibit transmission throughout the nervous system. Nociceptive pain results from tissue damage, the source of which may be mechanical, thermal, or chemical. Nociceptive pain occurs when pain-specific neurons are activated in response to noxious stimulation. Nociceptors are specifically sensitive to pain-enhancing substances associated with inflammation. Depending on its etiology, nociceptive pain may be described as dull and aching, sharp and burning, or cramping and pulling. Examples of nociceptive pain include: burns, cuts, and bruises, bony fractures, appendicitis, and pancreatitis. Factors that facilitate/inhibit pain transmission can influence sensation and/or unpleasantness The processes of pain signal transduction, transmission, and perception are dynamic and may vary greatly within an individual over time, as well as between individuals. Factors that may facilitate pain signal transduction and transmission...