Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Who Treats Chronic Pain?

chronic pain
Chronic Pain:

Assume an injured worker who is now in chronic pain. The patient is being treated at a pain management center. The patient is also depressed and referred for psychological care.

The pain and the depression are seen as different problems, and treatment is divided between a pain management center and a psychologist. Quite often there is little communication between the two offices.

Treatment in one office is seen as unrelated to treatment in the other.

The pain treatment center (or in some cases the primary surgeon, neurologist, etc) caring for the patient is unlikely to follow the progress of the treatment of anxiety and depression.

But here is the more concerning aspect:

Those treating the pain with medication and procedures do not necessarily believe that psychological (or personality for example) problems are related to the experience/complaints of pain.

There is new research that “chronic pain emerges as a result of an emotional response to an injury.”

Why do some fully recover while others experience and report chronic pain?

The aforementioned research (Lead scientist Professor Vania Apakarian from Northwestern University) suggests that occurrence of chronic pain cannot be explained fully by the injury itself but must be explained by a combination of injury and the “state of the brain”, specifically, two brain regions (frontal cortex and nucleus accumbens).   These theories are being supported by brain scans.

In effect, the more emotionally the brain responds to the injury, the more likely chronic pain will result. One brain area (nucleus accumbens) “teaches” the rest of the brain how to evaluate the injury and react to it.

In early studies, it was possible with 85% accuracy to predict which individuals would develop a chronic pain response to injury (results published in the journal Nature Neuroscience).

It is possible to teach those that are prone to develop chronic pain how to evaluate their injury and pain differently rather than to allow the chronic pain to develop and treat only the depression.


Pain Management

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