Chronic pain: what it is and how it is treated from Psychology.

The causes and effects of chronic Pain on the mental health of patients.

The chronic painChronic pain, which lasts longer than six months, is an experience that is not only quantitatively different from acute pain, but also, and above all, qualitatively different. How can it be dealt with? To find out, it is first necessary to explore what pain is.

How does pain work?

The idea that the feeling of pain depends solely on the physical damage produced (simple linear model) has been maintained for a long period of time. However, this way of understanding pain is considered insufficient to explain some clinical phenomena.

What about phantom limb pain, what about the placebo effect, why does pain seem to intensify in silence, in the dark of night, when we are in bed without any distractions?

Melzack and Wall proposed in 1965 the Control Gate Theorywhich holds that pain is composed of three dimensions:

• Sensory or DiscriminativeIt alludes to the physical properties of pain.
• Motivational or AffectiveReferring to the emotional aspects of pain.
• Cognitive or EvaluativeCognitive or Evaluative: related to the interpretation of pain according to attentional aspects, previous experiences, the socio-cultural context .....

What influence do these factors have? The perception of noxious stimuli is not direct, but there is a modulation of the message at the level of the spinal cord. This implies that in order to feel pain, the arrival of an "it hurts" to the brain is necessary. However, does the brain always receive this information?

The pain valve

According to the authors, there is a gate that allows (or not) the entry of this information into the neural pathway, depending on whether it opens or closes.depending on whether it opens or closes. It is the previously mentioned dimensions, the physical, emotional and cognitive factors, that control its opening or closing.

Over the last decade, Melzack has proposed a Neural Network Model which postulates that, although pain processing is genetically determined, it can be modified by experience. Thus, factors that increase the sensory flow of pain signals, in the long term could modify excitability thresholds, thereby increasing sensitivity to pain.

At present, it does not make sense to speak of psychogenic pain and organic pain. Simply put, in humans, pain is always influenced by psychological factors.This means that pain is not only experienced from the pain receptors to the brain, but also in the opposite direction.

Strategies for coping with chronic pain

What strategies do patients with chronic pain use to try to cope with it?

Among them are:

• Distraction of attention.
• Self-affirmationsTelling oneself that one can cope with the pain without great difficulty.
• Ignoring pain sensations. of pain.
• Increasing your activity levelby using distracting behaviors.
• Seeking social social support.

Different scientific studies have tried to find out which of them are really effective. However, the results are inconclusive, except for what is known about one bad strategy: catastrophizing.

What is catastrophism?

Catastrophism is defined as the set of very negative thoughts referring to the fact that there is no end to the pain, no solutionand nothing can be done to make it better.

Work conducted at Dalhousie University in Halifax by Sullivan and his team distinguishes three dimensions in the assessment of catastrophizing. These refer to the inability to put the pain out of the patient's mind (rumination), the exaggeration of the threatening properties of the painful stimulus (magnification) and the feeling of inability to influence the pain (helplessness). The results point out that rumination is more consistently related to this strategy.

The pain schema

Pain, as an unpleasant emotion, is associated with unpleasant emotions and thoughts. In an attempt to improve their quality of life, people try to suppress them. However, not only do they not succeed, but they also manage to make them stronger (producing the rumination that will keep them continuously active).

This activation is associated, in turn, with other negative emotions, which strengthens the catastrophic schema, which consequently biases the person's cognitive and emotional processing, contributing, once again, to the persistence of pain. In this way, one enters a vicious circle. How to get out of it?

Intervention of psychology in chronic pain

Setting as a goal the elimination of chronic pain can be not only ineffective, but also detrimental to the patient, as can an intervention aimed at promoting positive thoughts and emotions in this regard. As an alternative, we study the role of acceptance and Contextual Therapy in chronic pain.

The role of acceptance

Acceptance is the selective application of control to that which is controllable (as opposed to resignation, which attempts to replace control with no control at all). From this point of view, psychological interventions propose to patients strategies to improve their quality of life in a life with pain, without trying to eliminate it.

Although there is still little research along these lines, a study carried out at the University of Chicago shows that people who are more accepting of pain show lower levels of anxiety and depression, as well as a higher level of activity.in addition to a higher level of activity and work status.

Contextual Therapy

Contextual Therapy or Acceptance and Commitment Therapy, developed by Hayes and Wilson, has so far been scarcely applied to chronic pain. This consists of changing the function of the patient's emotions and thoughts (not modifying them (not modifying them in themselves). In this way, the patients are made to experience that emotions and thoughts happen to them, but are not the cause of their behavior, thus coming to consider which values act as the driving force of their behavior.

With respect to pain, he tries to assume its presence without trying to suppress it, involving himself in other vital activities oriented to different objectives.

Bibliographical references:

• Fernández Berrocal, P., & Ramos Díaz, N. (2002). Corazones inteligentes. Barcelona: Kairós.