Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


persistentPersistent & Severe: “There are some terms that continue despite their not being accurate descriptors.

A “cold” or a “stomach ache” or “a sore back” are such terms. They tell us little about either the source or the extent of the discomfort and suffering.

Chronic pain is such a term. We are familiar with pain, and we equate chronic pain with that which continues. It tells us nothing about the source or the intensity.

Attempts are made to move us to referring to the pain as “persistent and mild, moderate or severe” but even in that case, the descriptors fail to describe the experience of the pain and/or the resulting limitations.

Patients, both privately insured and workers’ compensation, consistently refer to “no one knows how bad this is, and how I am suffering.” And the patient is correct: anyone who has a severe back injury will hasten to tell you that “this is not like when you strain your back while gardening or playing golf.” And, indeed, it is not. The pain is persistent, severe, extremely limiting, and can/will take away hope and expectancy for quality of future life.

I do know, without hesitation, that those who have gone through repeated injections, physical therapies, and drug regimens become increasingly frightened by the implication that their pain is relentless and their life options very limited.

We ascribe to recovering addicts a greater capacity to assist those who are addicted. We do not expect those who treat pain to have also experienced severe and/or persistent pain.

Medication is a further problem: Restricting narcotics, drug testing for appropriate use, and difficulties with authorization for medications is a great concern to the patient. The patient, due to the drug abuse of others, is placed in the role of “Prove to me that you are not misusing the medication.”

Additionally, the medication itself often places the patient in a daily routine of anticipation of the next dose, side effects that erode the quality of daily life, and fear that whomever is prescribing may/will/must stop providing access to the medication. They also know that they have become physically dependent upon the narcotic(s) and cessation will lead to horrid withdrawal symptoms. In a circular fashion, some try on their own to limit their intact and are then accused of medication misuse, hoarding or even drug distribution to others.

If you are using a consulting psychologist, charge him with the task of insuring that the patient more accurately understands the nature and duration of, and treatment for, their pain, including how to build a life despite pain’s persistence.

American Board of Professional Psychology

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