People experience pain in many different ways. Pain is usually
regarded as a necessary protective mechanism that communicates
to us that we need to attend to an injury, modify our activity
so that we don't cause further pain, and it alerts us
to possible danger or damage.
Most people in the US tend to hold to the traditional "biomedical
model" of disease; that is, if someone is ill or in pain
there must be an observable organic condition causing it.
A related expectation is that once the particular condition
has been treated and provided the necessary time for healing,
the symptoms of the disease/discomfort will abate.
For many kinds of
pain these expectations hold
true, as the causes are clear and can be dealt with via medical
interventions such as surgery (e.g., removing a gallbladder
or repairing a torn ligament) or medication (e.g., analgesics
for a headache or antibiotics for infection). We also experience
acute pain when we stub our toe, burn ourselves on a hot stove,
bump into something, or our skin gets cut or scraped. Most
people's pain experiences are acute; that is, even if
pain is severe, it usually goes away quite quickly.
pain, however, is quite a different matter.
Most often the initial cause of pain can be identified, such
as when someone sustains a trauma (e.g., injury in the home
or workplace, during a sports activity, or on the road), a
severe burn, or undergoes a surgical procedure. In chronic
pain, pain continues on despite medical interventions and
beyond what we would normally expect. Pain is said to be chronic
if it lasts for a period of greater than 6 months.
Most people often misinterpret chronic pain as indicating
that something is terribly wrong; that is, that doctors have
"missed something" and/or that further damage is
occurring. Although we do not know exactly what causes most
chronic pain (or
chronic benign intractable
we do know that it is usually not a helpful communication
tool our bodies use. That is, it is usually not a "warning
system" that alerts us to the possibility of further
damage. In fact, most chronic pain appears to serve no purpose
Recent estimations place the number of Americans suffering
from chronic pain resulting in partial or total disability
at about 50 million. Estimates of physician appointments involving
Americans seeking medical assistance for chronic pain may
run to nearly 100 million visits annually.
Professionals who treat individuals with chronic pain are
often aware of the pervasive and often devastating affect
this pain can have on individual lives, including shaking
the very foundations of a person's being. Crises of meaning
are frequent for people with chronic pain as they try to make
sense of their lives in the face of significant challenges
to functional abilities and comfort. Along with physical limitations,
chronic pain engenders a host of emotional, cognitive, spiritual,
relational, and socioeconomic problems. While these difficulties
seem insurmountable, perhaps the greatest challenge underlying
these struggles is construing a new or modified worldview
that includes the inescapability of pain. Reorienting one's
expectations, self-perception, and future possibilities is
often a slow and arduous journey.
Chronic pain is widely believed to represent disease itself.
It can be made much worse by environmental and psychological
factors, and it can--and often does--cause severe
problems for patients.