Chapter 74 The management of pain
Pain is defined by the International Association for the Study of Pain as: ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. The experience of pain is subjective and dependent on past experiences of injury. Note that the definition includes the emotional experience, indicating that the pain perception is not just sensory. We often associate pain with an acute injury or event that is assumed to signal harm or damage. This may be an appropriate interpretation where pain has an obvious cause and is of recent onset. However, many people’s experience of pain is a more chronic picture. Chronic pain may present in a variety of ways and is estimated to have a prevalence of 10% in the population. Chronic back pain is one of the commonest causes of sickness from work and contributes to escalating figures for disability benefits.
Health beliefs and misconceptions
Health beliefs can powerfully influence people’s response to their symptoms and expectations of treatment (see pp. 38–39). If individuals with chronic pain believe that their pain is a signal of harm and damage, then they are likely to avoid doing things that will bring on pain. This usually leads to a gradual reduction in physical mobility and can result in secondary problems, such as postural changes, stiffness in joints or the lack of use of an affected limb. Individuals may be fearful of exercise and less compliant with advice. This kind of health belief can lead to anxiety and significant unhelpful behavioural changes.
Cognitive-behavioural approaches
There are three linked components to the management of pain: dealing with unhelpful patterns of thinking, which can then lead to changes in behaviour and subsequent improvement in mood (see pp. 136–137). These psychological principles can be applied by all clinicians who have contact with pain patients. A more integrated and intensive approach is commonly used in pain management programmes.
