successfully treat a chronic pain patient, very important to treat underline
psychological reasons behind the pain. We accept that all pain is real. This
may appear like an observable statement, but persons with chronic pain are
often treated as if their pain is either made-up or overstated. Some of this is
maintained by the mind-body dualism inherent in the medical model.
Unfortunately, this model continues to be alive and well in the medical community.
(Psychosomatic) dualism espouses the old dichotomy of “functional vs. organic”
when evaluating and diagnosing chronic pain. In the model, functional pain is
conceptualized to be of purely psychological etiology. A patient is often given
this label by the physician if a precise reason for the pain cannot be found
(identification of a pain generator).
this circumstance, the psychological etiology is a diagnosis by exclusion.
Given this situation, it is not surprising that many chronic pain patients feel
like they have to prove their pain to their friends, family, and doctors. There
are countless patients with stories of being told by doctors that there is no
“medical” reason for the pain and therefore “it cannot be that bad.” One of the
first tasks for the pain management is to establish with the patient that his
reports of pain will be believed. This is especially important since the
patient may be hesitant about seeing a “shrink” in the first place. We will
discuss this issue further under the initial interview section.
is a personal experience and cannot be measured like other problems in medicine
such as a broken leg or an infection. This causes a frustrating experience for
the chronic pain patient in interacting with the healthcare system, family, and
friends. Everyone knows that a broken leg can be confirmed by an x-ray and an
infection by a blood test measuring the white blood cell count.
there is no medical test to measure pain levels.
Thus, chronic pain sufferers will go from one
doctor to the next searching for medical explanations for their pain (and for a
cure). This can lead to unnecessary evaluations and treatments, in addition to
putting the patient at risk for actually being harmed or made worse by the