Chronic Pain: Psychosocial Factors in Rehabilitation

Abstract

The understanding and treatment of chronic pain is a challenge not easily met. By the time the patients arrive at a clinic, they have usually lived in that condition for a substantial length of time. The etiological factors are buried under a variety of radiographic, neurological, orthopaedic and psychological investigation. The patients tend to believe that they have a serious physical infirmity. . . . Unfortunately, some patients will not prove to have a disease to be removed, or pain that can be cured. The end results of prolonged disability associated with chronic pain are psychological, social, economic, and familial. Removal of pain is often an unattainable goal. The rationale for intervention with chronic pain patients must be sought in terms of enabling them to develop more effective ways of coping, and in the restoration of roles and functions, which tend to be eroded as the patient assumes his semi-invalid role. Here we see the polarity between the medical model and the rehabilitative viewpoint. The former aims to eradicate the disease that causes the complaint, whereas the latter takes the pain-disability problem as the focus of concern. Chronic pain is an inherently complex human experience, and by necessity, requires the use of diverse and sophisticated conceptual models to account for all its facets. The current literature reflects this complexity, with an ever-expanding body of basic theory and techniques; workers from many different medical and nonmedical disciplines have been applying their own language and theoretical frameworks. There is a growing awareness of the need for systems to conceptually link these varied approaches for the purposes of integrating and using the unique contributions of these coexisting methods of analysis. This attitude that strives for integration provides the "glue" that allows for ecological validity, and provision of a more comprehensive understanding, in our approach to chronic pain disability. It is important to realize that not all "pain treatments" are equally efficacious, and that questions must be asked regarding specificity-"which therapies, for which patients, and for what purposes?" With further refinements in thinking about pain, there has been development and perfection of research methodologies and measurement techniques, which are critical in evaluation of interventions for pain. In the succeeding chapters, the psychosocial factors relevant to the rehabilitation of the chronic pain patient are dealt with from various viewpoints. (PsycInfo Database Record (c) 2022 APA, all rights reserved)