He pain chronic Is a sensory and emotional experience associated with an actual or potential injury lasting over 6 months. That is to say that the pain is not only a physiological experience, but also psychological and can be experienced even if there is no real injury.
The sensation of pain is localized and subjective and varies in intensity, is experienced as unpleasant, but at the same time is adaptive. That is to say, thanks to the pain we can realize that something does not work and therefore, it helps us to adapt to the surroundings to be able to survive.
The pain brings out our authentic Personal values ; When everyday acts appear they become privileges that have been lost. That way you discover what really matters.
The problem arises when we make pain a way of life. Only acute pain fulfills a survival function, and is seen as part of the path of recovery of well-being. Chronic pain has no biological purpose, those who suffer from it say they feel that time has stopped.
In today's society, in industrialized countries pain is a serious health problem that affects 23.4% of the population (Catalá, 2002). People who have it have a high degree of Absenteeism And they lose a great number of hours of work, in addition they make use of pensions of invalidity and of excessive consumption of drugs, with which a clear incidence occurs in monetary level.
Pain psychologically affects people who react with stress , Depression, frustration, impotence, Defenselessness ... consequently developing behaviors of avoidance of activities so much social, labor or intimate relations that facilitate the maintenance and growth of this social isolation.
In turn, with isolation, people are locked in on themselves, are not related to other people and therefore originate certain emotional states that increase pain, with which the person retracts more than performing any physical activity That you think may affect you. This gives rise to a vicious circle difficult to break and the consequent"disuse syndrome", characterized by a loss of muscle strength.
And what strategies does the person with pain use to try to fight it?, because they resort to the use of drugs, maladaptive strategy that can lead to dependence, as well as undesirable side effects.
I am going to give you an example on how it could affect that a sharp acute pain could lead to a chronic pain if not remedied.
Imagine that one day you go down the street, you trip with a step and you fall to the ground, you hurt in the back, however you can not rest because you have to work, eventually the back is tense and each time Hurts more
Consequently, you start to do less activities and delegate them to others, but this is prolonged without realizing it more than 3 days. What does this mean?
Well, with prolonged inactivity the muscles shorten, tighten, harden and weaken, increasing the risk of fatigue, muscle spasm and pain. Before this you begin to consume drugs, this way you alleviate the pain but eye! You also favor that this inactivity be maintained. Over time it can lead to more pain, numbness, loss of reflexes and muscle weakness.
Mechanisms explaining chronic pain
The psychological approach to this problem requires the application of general clinical strategies and consideration of the physiological factors involved, as well as the perceptual basis of the problem.
From an analytical perspective, attention is paid to three components: behavioral, physiological and cognitive. In this way, all the possibilities of pain analysis are covered, in addition the triple response system of Lang of 1968 is accepted, facilitating the integration of the most appropriate clinical approach to the perspective of chronic pain.
The major contribution in this field came from the hand of Melzack and Wall with his theory of the door in 1966. It focused on considering the differential influence of different psychosocial variables on pain (motivational aspects, aspects of reinforcement and attentional factors), Putting at the same level of relevance the different factors that compose the pain experience, delimiting the relevance that these factors have in a given problem, thus orienting the treatment of the case according to the predominance of one dimension in function of another.
The theory of the door holds that the neural activity of the peripheral nociceptors (pain receptors) is modulated in the dorsal horn of the spinal cord, which acts as a gate that prevents or not the passage of nerve impulses that come from the nociceptors and the cerebral cortex .
When the door is open, the impulses that flow through the medulla reach the brain and the person feels pain. With the door closed the impulses are inhibited and do not reach the brain, so that the person does not feel pain. The door can also be opened or closed by downward messages from the brain. This system is known as the central control mechanism.
Information on pain experience is valued in the higher centers of the nervous system, transmitted to the limbic system (Involved in the emotional) and the Reticular formation (Involved in activation), and sent to the bone marrow to modulate the pain experience.
Thus, emotional reactions such as anxiety , Fear or stress can exacerbate the feeling of pain, while participation in other activities may silence it. In addition, the subject's beliefs as well as his previous experience would also affect.
To make the theory of the door clearer, I will give a few examples. Imagine that we are in the kitchen, we are going to take salt from the closet and we hit with the door of this one. The reaction of anyone will be to rub your finger to relieve this pain. According to the theory of the door this friction activates the large fibers that close the door, blocking the stimulation of the small fibers and diminishing the pain.
It can also happen the opposite situation, imagine that we are partying, dancing, we are having a great time, and suddenly we take a false step and we bend our foot. However, we did not notice the pain because of the excitement and concentration in the dance. The door of pain is closed by the information that comes from his foot. But, once we leave the party, and we are returning home we pay more attention to our organism, the door of pain is opening.
This theory was extended in 1993 by emphasizing the role of the brain in the perception of pain. We are talking about the neuromatrix theory. The neuromatrix is a network of brain neurons distributed through different areas of the brain that receives certain sensory information that would interpret as pain.
However, there are times that can be activated even if there is no such information, triggered by associated external or proprioceptive stimuli. This happens for example with phantom limb pain. The phantom limb pain occurs when a person has amputated limbs, such as an arm, a hand, a foot... and feels that the limb is still connected to the body and is working, producing painful sensations.
Based on the above, Melzack and Casey propose in 1968 three dimensions to understand the interrelation of the psychological and physiological factors of pain. Among them we find:
- The Sensorial-discriminative Through the nociceptors, and that explains the intensity of the pain and its location in the organism.
- The affective-motivational that refers to the characterization that the person makes of the pain.
- The cognitive-evaluative dimension referred to the role of attention, beliefs and thoughts have about pain, affecting the previous dimensions.
The behavior of pain
When the pain becomes chronic, it can be controlled under environmental conditions. According to Fordyce there are several ways to transform pain into operant behavior.
On the one hand, the behavior of pain can be Positively reinforced . For example, when the doctor prescribes rest if the person feels pain, or ingestion of painkillers, a situation can arise that is chronicled by showing the subject a painful behavior to access them.
Other maneuvers such as being cared for by family members and the doctor himself or a paid work leave also contribute to reinforce the problem. As a curious finding by Flor, Breitenstein and Fürst, it was observed that the greater the request of the couple, the more intense was the patient's perception of the pain.
In turn, we talk about the Negative reinforcement Of the behavior of pain when the consequences allow the subject to be free of unpleasant events and situations like conflicts in the work, personal confrontations or assumption of different personal responsibilities.
Finally, the patient's functional behavior No longer reinforced Because when the patient wants to undertake some activity, his social environment prevents it by appealing to his physical state, and recommending him rest, take medication and not try too hard.
In turn, we can mention all those discriminative stimuli that are associated with the behavior of pain. For example, a woman may know that if she complains in front of her husband, her complaints are taken care of, but that if she does at work, the boss does not pay attention. Doctors should also be aware of this point because their actions lead to such complaints.
There are several ways to experience pain, which can be acute or chronic, intermittent or constant, local or generalized... In addition, the forms of pain behavior can be very different.
We are faced with verbal complaints, which are not considered as important indicative; Analgesic maneuvers, such as warmth; Stop doing an activity; Protective movements such as holding a hand to the stomach or certain facial expressions. These can be acquired by imitation, by verbal instruction or by its social consequences.
Psychological factors modulating chronic pain
As I mentioned earlier the pain is in some degree disabling and affects all areas of life. People have deterioration in the affective and cognitive field.
With regard to the former, these patients feel misunderstood and blame the professionals of uncertainty regarding the etiology and treatment of their pathology. They also do not accept that they are insinuated that their pathology is psychological. Patients are reluctant to believe that their pain may be influenced by psychological factors and live this insinuation as if they will be blamed for their pain.
On the other hand, anxiety and depression Are the most present emotions in the subjects, arriving to end even in aggressiveness and suicides. However, you have to take into account the individuality of the person because, not all carry the pain in the same way, many adapt. It is here when the differentiation between pain and disability enters, understanding the latter as less quality of life At the physical, psychological and social levels.
Through the stress model of Lazarus Applied to pain, it is proposed that the painful stimulus that a subject suffers will more or less affect the subject depending on how he evaluates it and how he confronts it. The more threatening an event is evaluated and the less effective the coping strategies employed, the greater the degree of stress.
With respect to cognitive evaluation, we observed the existence of the catastrophic variables. Patients evaluate their pain as uncontrollable and exaggerate the threatening properties of the painful stimulus, not leaving pain in their minds.
This variable affects the moods And cognitive processes, such as attentional, Decreasing their ability to concentrate , Being able to verify that this also affects the memory.
On the other hand we talk about the Self-efficacy , Concept linked to the previous one since it refers to the capacity of the subject to solve or face a concrete situation. The more self-efficacious people feel less pain, manage better and show a lower disability and better results in treatments since they think their pain is more controllable and experience less anxiety.
As for coping strategies, these are defined as cognitive and behavioral efforts to overcome the potentially threatening situation. We find active strategies and other more passive (hopeful fantasies, pray...).
On the other hand, Expression of emotions Also influences, those people who do not express their emotions experience more pain. As for the search for social support, there is an inverse relationship with respect to an adaptive strategy. Taking medication can also be considered as coping strategy, some are over-medicated and others for fear of side effects do not follow medical prescriptions.
Predictive variables
Apart from these variables, a great deal of research has been done over the years that seems to be predictive of pain and / or disability.
People who consider their pain as a totally physical disorder often prefer more medical therapies and do not usually agree to participate in interdisciplinary or psychological programs, and if they do, they usually give up or show little adherence. The locus of control also influences, those with an internal locus of control (those who believe that pain depends on themselves) are the ones who are best suited to their situation.
With regard to personality traits or psychopathologies, it has been seen that anxiety and depression are the most related. In addition, the relationship between neuroticism and chronic pain seems to be mediated by the catastrophism already discussed above.
Regarding the previous history based on studies, the following has been determined: chronic parental pain, history of sexual abuse and any type of stressful event can affect pain.
Social support indicates that those patients with greater support will have more opportunities to express their feelings about the pain and can obtain more information and help to solve the problematic situations that arise.
Finally, the educational level shows that those with a lower level have more catastrophic thoughts and a greater tendency to think that the pain signals physical damage.
CONCLUSIONS
I hope this article has been of interest and above all that you have learned that experiencing pain is something natural and allows us to survive, but if it becomes a lifestyle, the consequences can be very difficult.
Bibliography
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- Cuatrecasas Cambra, G. (2009). Stress and chronic pain: an endocrinological perspective. Clinical rheumatology 5 (s2): 12-14.
- Moix Queraltó, J. (2005). Analysis of psychological factors modulating chronic benign pain. Barcelona. Anuario de Psicología, vol, 36, nº 1, 37-60.
- Vallejo Pareja, M.A. And Comeche Moreno, M.I. (1992). Considerations about the conceptualization of chronic pain. Psicothema, vol. 4, no. 2, pag., 379-383.