Dealing with pain
Author: Dr George John
Pain is the most common symptom encountered in the GP surgery and is usually associated with a simply physical condition. Psychogenic pain is pain that has no obvious physical cause.
In fact physical pain is commonly a symptom of a psychological problem rather than the other way around. Illnesses such as depression, anxiety, stress, etc. very often have painful and sometimes quite severe physical side effects.
Chronic pain may also be a result of damaged nerve endings following physical injury, where the injury itself has been repaired, but there is a residual pain, which may no longer have a physical cause but nevertheless is very real.
Sufferers of pain can be any age, but research has shown that it is most common among the middle-aged and women suffer more often than men.
What are the symptoms
The face is the area of physical pain most frequently associated with psychological problems. Headaches are usually linked to tension and various degrees of anxiety.
Chronic abdominal pain is common in children and adolescents, while backpain is more often encountered in the middle-aged and elderly.
Why do we feel pain
Age, sex, personality and cultural background play an important role in how we respond to pain. Our past experiences of pain such as failure of treatment, disruption to daily life, etc may also influence our attitude towards it.
Social and environmental factors are also important influences. We may even welcome pain if it draws our attention away from other problems.
Sometimes our physical pain, whether real or perceived may even be a subconscious attempt to communicate emotional distress or other feelings.
How is it treated?
The management of chronic pain is a major problem for all doctors, despite considerable advances in its understanding. The initial aim is to control pain and there are a number of ways the individual can be helped to cope with it.
Medication: Analgesics are usually ineffective in psychogenic pain, yet some medications such as anti-depressants may be helpful in some cases.
Invasive procedures (injections) may be prescribed but these carry risks and the specialist should always be asked about success rates and side effects.
Counselling and family support: Referral to a qualified specialist such as a Consultant Psychiatrist or Psychologist may also help to provide support. Often advice will include relaxation, stress and anxiety management, coping techniques and psychotherapy.
For many people, simply talking about their feelings provides the psychological support they need. The family should also be involved in any medical treatment and possible family problems should be explored.
Exercise and diet: Many people tend to swing between complete inaction and all-out activity, which increases pain and demoralises them. Often we avoid activity because we expect it to hurt, which leads to increased pain and is compounded by our belief that we may not be able to control it.
Exercise is extremely valuable but it is important to aim at realistic, moderate steps. This will improve confidence and self-esteem and help to keep progress continuous.
Pain clinics: There are over 200 pain clinics throughout the UK of varying quality, the best of which will have a team consisting of anaesthetist, physiotherapist, physician, GP, psychiatrist, psychologist, occupational therapist and nurse. This enables a "holistic" approach, looking at physical, psychological and social aspects of pain management.
Alternative therapy: Acupuncture is helpful for some patients to reduce pain temporarily, along with massage, aromatherapy, hydrotherapy, physiotherapy and hypnotherapy. Increasingly these are available on the NHS but only via the GP.
Self help groups: For general support and advice, several associations exist for individuals to share experiences and may be helpful in understanding more about the nature of pain.
Simple hints and tips
If you do suffer from chronic pain, there are one or two additional things you can do to help alleviate the symptoms.
- Relax - learn some relaxation techniques to reduce tension in your muscles
- Diet - make sure you have a healthy, balanced diet and eat regularly
- Exercise - take regular and moderate exercise, without over-exerting
- Visualise - spend time creating images in your mind which help you change pain into something more comfortable
- Be patient - try not to become anxious about curing your pain all at once. Think about dealing with certain aspects of it at a time.
- Learn about pain - understanding pain helps to reduce fear and resistance and will enable you to take on board better coping strategies.
