Pain & Its Management: Time is of the Essence

Alarm ClockThere is a significant difference between acute versus chronic pain.  Acute pain is typically characterized by a temporary decrease in activities, reliance on medication and seeking the appropriate medical intervention, with the entire acute phase lasting no more than several weeks.  In persistent, or chronic pain, alterations in patterns of behavior begin to emerge, including decreased activity levels and continued reliance on medications.  Patients may also attempt to continue working as a coping strategy, with an increased focus on their symptoms because they are beginning to realize that they are “not getting better.”  Not uncommonly, anxiety begins to appear, as well as possible depressive symptoms, all of which can exacerbate the underlying perception and intensity of pain.  Simultaneously, patients with chronic pain continue seeking medical care.  While such patients hope for an ultimate cure, the treating physician(s) begin to speculate about the patient not improving to the expected degree, given the structural diagnosis.  Accordingly, the medications continue, as well as other clinical interventions, i.e., physical therapies, nerve blocks, or other diagnostic procedures, etc.  By this time, very little new information is forthcoming as to why the patient is not improving as expected.  Simultaneously, the patient frequently continues to deteriorate physically, as well as emotionally.  By this time, the treating physician and patient likely do not know why progress is not being made, leading to a situation that is essentially “out of control.”  Since the treating physicians do not understand why the patient is not progressing, the natural tendency is to continue prescribing the same or similar treatments, all to no avail.

It must be understood that the presence of chronic pain is not limited to the structural or physical abnormality.  Chronic pain includes the structural portion, as well as the cognitive (what you think about your pain), the emotional component (how you feel about your pain), and cellular memory (prior events that are stored in memory that may be impacting your present condition).  In other words, chronic pain involves all four components.  Traditional medical practice, however, is typically limited to focusing on the structural (physical) component.  Traditional medical practice is the treatment of “body parts” rather than the entire individual.

The passage of time contributes to the development of chronic pain in some people due to the potentially negative influences of what we think, how we feel, and our history of prior events which may play an important role in the creation and maintenance of chronic pain.  As a result, time is of the essence.  It is well known in the medical field that the earlier the intervention, the better the outcome.  If an acute medical problem becomes chronic when not expected or anticipated, then other factors are likely operating to create and maintain the chronic problem.  When faced with such a situation, the individual would be best served by seeking out the services of a psychologist, or other mental health specialist, experienced in the evaluation and treatment of such situations.

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