Chronic Pain

Summary

Chronic pain is often a disabling injury. While pain is a sign or symptom of a primary problem, if that problem is not diagnosable or treatable, the chronic pain syndrome is pushed aside. Physicians who accept the responsibility of treating an individual’s illness must deal with the “whole man.”

I. Introduction
 
This writer has, over the last years, written and lectured at some length on the subject of pain. It has been my thesis that the devastating effect of chronic pain is not well recognized by either lawyers or doctors. Both professions have considered pain to be a sign or symptom of some other more primary problem. …/… 

If that problem has not been diagnosable or treatable, the chronic pain syndrome has been pushed to the side. I believe that chronic pain is and should be dealt with as an independent often disabling injury.
 
Chronic Pain General Information
 
Because pain is always a subjective state that can only be perceived by an individual it is difficult for a physician to accept its existence in the absence of a physical finding that there is a competent producing cause of the pain. Nevertheless, science has long recognized that the experience of pain is not dependent upon ongoing stimulation from injury. Pain from anatomic injury, often called peripheral injury stimulation, becomes less important as time goes on.

Contrary to many assumptions pain is not a simple response to injury. Tissue damage itself does not produce pain. Pain is a biological and psychological phenomenon reflected through the central nervous system. The injury acts as a stimulus to the brain and the cognitive process creates the sensation of pain. …/…
 
The physiology of pain has both a neuroanatomic and biochemical explanation. Nerve fibers transmit pain impulses to the spinal column. Within the spinothalamic tract neurons extend to the thalamus which then extends neurons to the parietal cortex. It is also thought that serotonin plays a role in the genesis of pain due to vascular occlusion.

Thus, it is thought that both neurologic and metabolic systems play a role in creating pain. With an understanding of the physiological etiology of pain acute pain may be managed by eliminating or interfering with its cause.

II. Chronic Pain Treatment Results
 
Chronic pain, however, may not be responsive to such treatment and may cause great frustration for both the physician and the patient. All too often such people are discarded by their doctors and lawyers as being either malingerers or neurotics. Who can wonder why such people become depressed and resentful and focus almost exclusively on their pain?

Individuals suffering from chronic pain have severe and recurring pain for months and even years. …/…
 
The amount of pathology present is insufficient to explain the intensity of the pain. Yet, the chronicity of the pain is devastating to the personality and even the existence of the sufferers.

Chronic pain, unlike acute pain, serves no function. It indicates a biopsychosocial breakdown. It is a multidisciplinary and multidimensional problem and must be treated as such.
 
Assessing Chronic Pain
 
Assessing chronic pain is a difficult task for a physician because all pain is subjective. Chronic pain patients are often anxious and difficult to communicate with. Physicians frequently assess all pain as acute pain; whereas, patients with chronic pain usually exhibit vegetative changes rather than the “right or flight” response of acute pain. This often leads the health care professional to wrongfully assume malingering.

Physicians must distinguish between chronic and acute pain because the method of management of one may be contraindicated in the management of the other. …/…
 
Pain persisting over long periods of time causes a multitude of physiological and psychological changes all of which need to be addressed.

It needs to be understood that chronic pain represents a crisis for the individual. Nothing in their prior learning or experience has taught them how to deal with it. Thus, if a physician tells his patient that “there is nothing further that can be done” or “you have to learn to live with it,” the patient may be condemned to live the life of a cripple.

III. Chronic Pain Complications
 
Studies have shown that chronic pain patients who have been discharged by their physician may develop a number of insidious complications. Some patients become increasingly passive and dependent on others. Family life is disrupted and all physical contact avoided.

It is usual in chronic pain patients to see a loss of self-image and resulting depression. Distinguishing between pain and depression at this point is extremely difficult.

Chronic pain serves no biological function. It is an enigma that takes a devastating toll on an individual’s life. A patient with chronic pain dreams of escape from a pain-riddled existence. Often they attempt such escape through abuse of drugs or alcohol.

It is accepted that all chronic pain patients experience suicidal thoughts. …/…
 
Suicide is regarded as a way out of an impossible situation and also as a means of providing a better parent or spouse.

Most chronic pain patients have great difficulty with their interpersonal relationships and eventually these relationships may be destroyed, further devastating the suffering individual.

It is necessary for the primary care physician (and the lawyer in a tort or compensation situation) to understand the terribly destructive effect of chronic pain and to take steps to treat it. Often such treatment involves multiple disciplines and even some type of psychosocial management. To walk away from the problem because of the absence of a clear anatomic cause is to do a disservice to the individual.

IV. Conclusion

There is today much greater knowledge about chronic pain and a wider variety of coping methods. Often the suffering individual requires a combination of behavioral modification, cognitive behavioral approaches, medical treatment and psychosocial management.

Physicians who accept the responsibility of treating an individual’s illness must deal with the “whole man.” A patient who has a loss of function as a result of chronic pain must be treated even though the anatomical abnormality might have healed. Lawyers and doctors must consider the social implications of illness and disability if they are to meet their responsibility to their client and patient.