Chronic pain.

Abstract

The definition of pain has remained elusive (Feurestein, 1994). Because pain is often considered a subjective phenomenon, some consider it t o be whatever an individual says it is. Sarno (1991) believes pain to be a response to maladaptive, repressed, or unresolved negative emotions. Most accept pain as a multidimensional problem having both affectiveemotional and sensory-discriminative components as outlined by the International Association for the Study of Pain (IASP; Merskey & Bogduk, 1994). More recently, there has been greater attention to conceptualizing pain as a disease rather than a symptom (Cousins, 1999;Liebeskind, 1991). Clearly, the definition one chooses influences assessment, diagnostic, therapeutic, and outcome measurement strategies.Pain is frequently divided into two categories, acute and chronic. Acute pain is generally associated with some defined tissue damage or disease process and is short lived. Chronic pain has been thought of in several ways (Feurestein, 1994). On occasion it has been defined by the duration of pain; historically, 6 months has been the cut-off but in some instances 3 months has been applied. In other circumstances, the term chronicity has been used to refer to pain complaints and symptoms that were considered to be qualitatively or quantitatively disproportionate to the underlying physical pathology. Some definitions associate the term with the type and degree of comorbidities, and individuals are considered to have chronic pain if they develop concomitant depression, anxiety, disability, or drug abuse.Pain is further subdivided into cancer and noncancer. Cancer pain specifies the etiology as some type of cancer. The assessment and treatment of cancer pain has historically been related to amelioration of the cause or palliation. Although frequently undertreated, pain secondary to cancer has been more widely accepted and less controversial than pain of noncancer origin. Improvement in quality of life and pain control are related t o both types of pain. However, restoration of function and what one ordinarily thinks of under the rubric of rehabilitation is a more common concern with noncancer pain. This chapter focuses primarily on noncancer pain, although there are similarities in assessment, treatment, and psychosocial issues between cancer and noncancer pain (

Psychologists as Leaders of Multidisciplinary Chronic Pain Management Teams: A Model for Health Care Delivery.

“…Changes in health care and the insurance industry have mirrored technological advances, which, at times, replace self-reliance rather than partner with it (Doleys, 2000). For example, insurance companies often approve a $20,000 medically invasive procedure, such as a morphine implant for chronic pain management, as opposed to a less expensive, comprehensive approach of an outpatient pain rehabilitation program.…”

“…The question is not simply whether a patient should receive a particular type of treatment but rather under what circumstances and at what time within his or her treatment plan. Psychologists must lead the team to develop therapeutic approaches to deal with the individual dynamics of patients rather than screen for patients who seem to fit a defined treatment protocol (Doleys, 2000).…”