PHYSIOLOGICAL: PSYCHOLOGICAL COMPONENTS

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PHYSIOLOGICAL: PSYCHOLOGICAL COMPONENTS

Physiological elements

A large proportion of chronic pain patients do demonstrate physical pathology ranging from slight to questionable, such as minor degrees of arthritis and degeneration of areas such as the cervical spine, and to a great degree in conditions such as terminal cancer. Adequate, assessment includes the scientific assessment of these processes, such as physical findings, X-rays, electromyograms or EMGs, and CAT scans which may all be important depending on the type of pain.

Psychological pain

Psychological pain is just as keenly felt with or without a physical cause. We are just as disabled if the pain is partly, or wholly, from psychological causes and may require just as much help. In the final analysis, when all the fancy definitions are stripped aside, ‘pain is what hurts!;

Acute pain is associated with anxiety and chronic pain with depression and the resultants alterations in mood, self-concept and thinking. It has also been shown that 50 per cent of depressed hospital patients have pain as a major symptom. Almost all published reports on the psychological and psychiatric evaluation of chronic pain patients report depression as a major component. This is often marked although patients themselves may deny being depressed.

Another important concept has been described that replaces the older concepts of functional or psychogenic illness. This is called sornatisation. This refers to the physical expression of emotions such as sweaty palms, rapid pulse, gastric hyperacidity, increased blood pressure, slowing down of movement, and early morning waking and depression. Sornatisation also refers to, and includes, the concept of psychogenic disorders, or mind-caused disorders also known as ‘conversion disorders’. For example, blindness, hysterical paralysis, deafness and finally pain caused by emotional factors. Briefly, sornatisation is a physical expression of an emotional or psychological disorder such as anxiety, gross stress and, occasionally, severe depression. Thus, one of the difficulties in diagnosing, and treating, chronic pain patients is that it is often difficult to decide what are the physical and/or psychological components of the pain symptoms.

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