Chronic pain you need to know

He chronic pain It is the symptom due to antonomasia in medicine, and the most common cause to visit the doctor. Traditionally pain has been considered as a specific sensation against harmful stimulation.

Therefore, it would be the result of tissue damage or organic pathology, being its intensity proportional to the amount of the lesion. Would have an adaptive function when indicating the presence of an injury.

This approach has been simplistic: You can inform little or no pain after a wound, not feel pain at the time of hurting. In addition, in some injuries, they take up to 9 hours before the appearance of pain.

Not to mention the pain of the ghost member, The very common presence of pain without any physical cause, Pain by "empathy", etc.

Content

• Chronic pain: in search of detectable evidence
  • Pain has multidimensional nature
• Types of pain
  • 1. Acute pain
  • 2. Chronic pain
• Explanatory factors of chronic pain
  • 1. Learning factors
    • 1. 1. Direct positive reinforcement
    • 1. 2. Punishment and extinction of usual patterns of patient behavior
    • 1. 3. Negative reinforcement
    • 1. 4. Environmental contingencies in patient behavior with chronic pain
  • 2. Cognitive factors that affect chronic pain
  • 3. Vital events
  • 4. Coping strategies
  • 5. Biological factors of chronic pain
    • Let's look at some data
  • References

Chronic pain: in search of detectable evidence

In many cases of chronic pain there is no detectable evidence of tissue damage. In addition, the pain is usually disproportionate to the seriousness of the lesion, being able to maintain even after blocking the pain transmission routes.

Instead, this may disappear by hypnosis, suggestion or placebos. This indicates that the experience of pain, at least the chronic, does not refer exclusively to the sensory aspects of the phenomenon, but is multidimensional nature.

Pain has multidimensional nature

These dimensions interact with each other, so They can be influenced each other:

• Sensory-discriminative dimension, whose function is to transmit the harmful information facilitating the discrimination of the physical properties of the stimulus, spatial location, intensity, etc.
• Motivational-affective dimension, whose function is related to the characterization of pain as unpleasant and aversive. It facilitates the dislacantly emotional experience, which raises escape responses, avoidance and protection behaviors. As well as emotions of anxiety and depression associated with pain.
• Cognitive-evaluative dimension, involved in the interpretation and valuation of pain. Its sensory characteristics and other factors such as attention aspects, previous experiences, sociocultural context, beliefs associated with pain, the level of perceived control, the attributed processes on the cause, etc.

Types of pain

As for the types of pain, the acute and chronic can be fundamentally distinguished.

1. Acute pain

He acute pain It refers to the case that there is a well -defined damage or injury from which the pain like a symptom (Bone fracture, toothache, etc.). It has a rapid appearance and subsequent maintenance over a more or less broad period until the cause disappears.

This associated with high levels of anxiety, proportional to the severity of the lesion. The changes in the physical and social environment of the patient due to pain are short (less than six months) and after healing the repertoire of social behaviors is automatically restored, without requiring a resentment.

2. Chronic pain

He chronic pain It begins as the acute, because of a wound or injury, but persists after healing. It is not a symptom of one wound or other organic pathology. The duration is very prolonged (more than six months).

It is usually associated with high levels of anxiety and subsequently to a high degree of depression. Patients describe pain more in emotional terms than sensory.

HE They produce permanent changes in the physical and social environment that modify the usual behavior of the patient and their families.

Medical procedures provide effective means of acute pain treatment. However the chronic pain, Result of a complex interaction between psychological and biological variables, a multidisciplinary approach is required.

Explanatory factors of chronic pain

1. Learning factors

From the learning perspective, If the physiological cause of pain will be extended for several months, it is very likely that learning effects occur and conditioning. Therefore, they can make pain persist once the physical causes have disappeared.

To do this we can distinguish three mechanisms:

1. 1. Direct positive reinforcement

Attention of the medical, family and social environment of the patient in the face of pain behaviors can become a source of reinforcement Able to keep this complaint behavior on its own.

Also, it is usual prescribe the rest continuously and abandonment of work when pain begins to feel. The administration of analgesics, compensation and economic subsidies, etc.

Thus, Patients with chronic pain are exposed to multiple sources of rewards economic and social that can condition their symptoms and maintain the disorder.

Both types of rewards are positively associated with more lost days of work, more disability in the domestic sphere and more levels of depression. But differentially, patients with more social rewards have higher levels of pain and more nonspecific medical complaints.

If you pay patient attention for their pain behaviors, they respond congruently, they follow the expectations deposited in them. In fact, you reinforce their beliefs about the truth of their pain.

The conclusion is that exposure to the two types of rewards explains a very significant amount of variance in the behavior of the patient with chronic pain that cannot be explained by biological variables.

1. 2. Punishment and extinction of usual patterns of patient behavior

After the appearance of injury or illness, medical staff and family members They express concern about any patient activity that implies physical work. Therefore, these behaviors are systematically punished, or are not followed by positive reinforcement. In this way, its emission is reduced until it is extinguished.

1. 3. Negative reinforcement

This is a fundamental mechanism. In the acute phase of the problem, Physical exercise or work is associated with pain, as well as all activities or situations in which episodes of pain have occurred.

The rest is followed by the decrease in pain and, therefore, is negatively reinforced. In fact, the physical injury of any physical work is maintained after missing the physical injury.

The phobic avoidance of the situations and activities associated with pain will also be maintained. Therefore, avoidance not only of movement and activity, but also of social interactions and any stimulation associated with pain is the most prominent component of pain behaviors.

In addition, the issuance of complaints is followed by the avoidance of work, Elimination of noise levels, anxious situations, stress and burdensome responsibilities.

1. 4. Environmental contingencies in patient behavior with chronic pain

The attention and request of the spouses towards the complaints and pain of their couples increases the frequency of this type of behavior and the Subjective pain intensity that informed patients.

When patients with chronic pain increase physical exercise rates, which previously avoid, pain behaviors decrease.

Both data They show that pain behaviors are partly low environmental contingencies. In the face of treatment, it is basic deprogramming some of the behavioral adaptations developed to deal with pain, especially withdrawing passivity and increasing physical exercise.

The learning of the behaviors that are exhibited before the pain is made mainly through vicar learning. Such is the importance of social modeling that has been experimentally The exhibition To tolerant models (People who cope with their problems without complaining and in a comedy way) Versus intolerant (Exaggerated complaints, disability samples, etc.) make their own levels of pain tolerance and pain reports perceived by experimental subjects modified.

In the case of chronic pain, it is common to find families whose members have very similar pain problems, regardless of organic causes.

The exhibition, especially in childhood, to models that exhibit pain or hypochondriac beliefs exaggerated or diverted is a learning source of behaviors that facilitate the subsequent development of abnormal pain patterns. Thus, it is not surprising that conventional treatments can make ineffective when disorders with pain are produced.

2. Cognitive factors that affect chronic pain

In the experience of pain, affective and cognitive-evaluative dimensions are also important. An important element in chronic pain that can foster a process of sensitization to pain is the development of cognitive biases.

We can distinguish Two types of biases:

• Interpretive bias. The subject evaluates pain and sensations linked to him as very negative, giving him more importance than they have.
• Attentional bias. The previous evaluation bias gives rise to a bias in attention: the subject pays selective attention to this type of sensation, the attention is constantly focused and concentrated in those bodily areas and sensations (attentional hypervigilation).
  • Therefore, it can cause a perceptual awareness and that the perceptual threshold drops. This entails that poor intensity sensations are perceived as painful.

3. Vital events

It is common that In patients with chronic pain problems there is no biological cause that can explain the intensity of pain. But a high prevalence of chronic stress and traumatic vital events (physical and sexual abuse) can be found (physical and sexual abuse).

In these patients it is usually frequent to find a Personal history characterized by suffering, social isolation and misfortune. Also, with chronic stress elements, traumas, sexual abuse or physical abuse.

The disorder is usually initiated in association with stressful vital events and results in Alterations of slow sleep, fatigue, a very low painful threshold, greater sensitivity to stress, etc.

4. Coping strategies

Patients with chronic pain develop certain coping strategies to try to face their situation. These can affect physical and psychosocial functioning. In addition, they are tremendously relevant to determine the rehabilitation or maintenance of chronic pain.

People with high pain tolerance:

• They tend to consider it as a problem that must be solved
• They occur hopeful self -instructs
• Do exercise
• They are not abandoned to disability status
• They do not make pain in the main focus of attention

People with low pain tolerance:

• Pain acts as a stimulus to start self -referent thoughts of catastrophist
• Abandon possible confrontation responses
• They exaggerate their inability
• They turn to pain in the main object of attention
• Catastrophicate the consequences from pain
• They are increasingly sensitized, entering a helplessness about the problem

The degree of conviction that the patient has regarding his ability to undertake activities and tolerate pain is decisive that he initiates and persists in strategies of Coping To face and overcome the pain problem.

Something to keep in mind is that in many of these disorders it can be seen that the search for medical help is more based on the psychological functioning of the patient than of the severity of symptoms.

5. Biological factors of chronic pain

There is Selective filter in the marrow that forms a door mechanism that determines that stimuli will pass to the brain. This mechanism is modulated by Painful sensory afferences to the medulla and inputs of the Mesencephalo and the cerebral cortex. The interaction of these three inputs selects the type of stimuli that will travel to the brain.

Therefore, previous experience, cognitive interpretation, personality, motivations and emotional variables, etc. They can influence this mechanism, so that the painful experience is greater or less.

Let's look at some data

• At the physiological level, a sensitization of the nocioceptors can be developed And a great Neurons excitability of the posterior antlers of the marrow and the reticulus-themic-chartical system.
• There is currently the opinion that Most chronic pain problems (headaches, low back pain, fibromyalgia) They have their origin in the central nervous system (CNS), more than at peripheral level.
• The origin is in the CNS, in a Alteration of pain mechanisms. Nerves and cells not specialized in transmitting pain are activated and this function is carried out, a neuronal restructuring occurs. Thus, these neurons specialize in the perception of pain.
• Also, in many of these patients, a State of exhaustion of serotonin, CRF, acth, cortisol and catecholamines levels. This deficiency cause fatigue, pain, sleep and mood disorders.
• Some authors speculate that the chronic pain could be conceptualized as a Atypical variety of depression. It is also known that there are genetically determined differences in the number and sensitivity of opioid receptors, the substance P or the same serotonin.

References

• Barroso, a., Hasvik, e., & Rodríguez-López, M. J. (2018). Education program in neurosciences and pain for patients with chronic neuropathic pain: pilot study. Magazine of the Spanish Pain Society, 25(1), 51-55.
• Sepulveda, j. D. (2018). Definitions and classifications of pain. Ars Medica Magazine of Medical Sciences, 23(3).
• Serrano-Ibáñez, e. R., López-Martínez, a. AND., Ramírez-Master, c., Ruiz-Párraga, g. T., & Zarazaga, R. AND. (2018). The role of behavioral approach and inhibition systems (SAC/sic) in psychological adaptation to chronic pain. Rev SOC ESP Pain, 25(Suppl 1), 29-35.
• Soriano, J., & Monsalve, V. (2019). Personality and resilience profiles in chronic pain: utility of the CDRISC-10 to discriminate the resilient and vulnerable types. Magazine of the Spanish Pain Society, 26(2), 72-80.