Paliatívna medicína a liečba bolesti Brožúra Liečba chronickej bolesti/2011

Psychological aspects of chronic pain

Pain is a sensory-affective signal of threatening or damage of an organism. Pain can function as a symptom of one specific pathophysiological state, as a symptom of more pathophysiological states, or as a false signal corresponding with no pathophysiological state. Acute pain is a signal of the highest priority. It induces immediate fear and focusing of attention on pain. Cognitive processes concentrate on pain and behavior targets at minimization of injury. If these processes continue in the phase of chronic pain, they deform and, as a rule, do not correspond to any pathophysiological state. Fear and observation of pain induced by acute pain and cognitive processing of pain elicit coping (assessment of pain, assessment of one’s own abilities to challenge pain and choice of solution). The results of coping processes are active resistance or anxious avoidance and surrendering. These processes are a crossroad between adaptation and recovery on the one hand and between maladaptation, suffering and learned pain behavior on the other hand. Suffering involves an affective component, including anxiety, anger and depression, and a cognitive component, including self-assessment and assessment of one’s own life as devaluated by pain. Learned pain behavior is a result of secondary gains from pain and a result of learned use of relieving pain instruments. The psychological treatment of chronic pain involves control and correction of patient cognitions, affects and behaviors. The patient’s attention is shifted from somatic symptoms and difficulties to active life. Pain management in patients with malignant disease involves assessment of cognitive and affective aspects of their suffering which demand specific treatment.

Keywords: chronic pain, coping with pain, adaptation, suffering, pain behavior.