Pain Management
An Unpleasant Experience Psychiatric Perspectives on Pain Eve R. Maremont, MD
In the opening of her recent book, The Pain Chronicles, writer Melanie Thernstrom compares the current experience of chronic pain patients with the plight of individuals diagnosed with “consumption” on the eve of scientists discovering the true cause of their illness: “Surely the consumptives would
have felt relief, mixed with wonder, to finally know what their disease was—and what it was not. It was not a curse. It was not an expression of personality or a punishment. For better or worse, it was and is a disease.” While there is increasing evidence for a neurobiological basis for chronic pain, the actual experience of patients dealing with it is still highly complicated by social stigma. As with conditions such as fibromyalgia, chronic fatigue syndrome, and “functional” bowel disorders, there are still more questions than answers about the true etiologies of these conditions. Inevitably, patients and their doctors are left grappling with uncertainty and frustration. 12 13
San Francisco Medicine April 2012
All Pain Is Not Created Equal Pain complaints can be divided into two categories. Acute pain is usually associated with an identifiable tissue injury and typically resolves in conjunction with the healing of the injury. Treatment interventions are targeted at pain reduction and limiting duration of injury. Acute pain may serve as a trigger for anxiety, PTSD, or even depression and consequently trigger a request for psychiatric consultation, particularly in the inpatient medical setting. In the absence of a major trauma (for example, acute pain associated with an assault), acute pain states are, by definition, time-limited. Chronic pain, on the other hand, is a common complaint for patients across medical specialties. While commonly triggered by an injury or disease state, chronic pain persists beyond these initial conditions. The intensity of the pain may be out of proportion to the original injury or may arise in the absence of identifiable pathology. This latter scenario often leads to deep frustration on the parts of both patient and providers. www.sfms.org