For most healthcare professionals, pain is a part of our daily routine.

We see acute pain caused by recent ailments or surgical procedures, as well as chronic pain from past injuries. Unlike acute pain, chronic pain continues beyond the expected healing time of the injury and is often difficult to treat. Most therapies and procedures look at reducing the pain, not curing it (McAllister 2015). Chronic pain has a fluctuating and unstable progression that leads to the individual feeling uncertain about the future. Challenges faced by health professionals who struggle when unable to cure a patient are often caused by this pathway of chronic pain.

According to the Institute of Medicine (2011), "chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity."

Increases in Negative Feelings

Chronic pain affects every aspect of an individual's life, including their relationships with others, employment, and ability to participate in normal activities. Clearly, when any condition has this level of impact on a patient's life and that of their loved ones, it’s no wonder they are likely to experience negative emotions.

As well as treating the physical and functional disabilities related to pain, nurses also need to look at the psychological and emotional consequences of suffering from chronic pain. These individuals have a fear of being judged negatively, experience mental defeat, and have higher levels of shame and guilt than people who are healthy (Turner-Cobb et al. 2015). As you can imagine, these feelings lead to further negative feelings which, in the end, could result in depression and anxiety.

Chronic Pain and Depression

There is a strong link between chronic pain and depression, and although this is widely known, depression often remains under-diagnosed in individuals with chronic pain. Left undiagnosed, it can lead to exaggerated symptoms, with patients reporting a higher pain intensity and loss of functional ability (Salazar et al. 2013). Both conditions, when co-existing and not controlled, exacerbate all associated symptoms. Therefore, a person with both chronic pain and undiagnosed depression is going to have an increased level of pain compared to that of an individual receiving treatment for their depression. It is therefore essential that health professionals identify any comorbidities present that have the potential to increase their pain levels and delay the effectiveness of their chronic pain treatment.

Pain Catastrophising

Pain catastrophising involves the magnification of pain symptoms leading to increased levels of depression, an increased sense of helplessness, anxiety and consequent functional loss (Block and Cianfrini 2013). It occurs as a result of the manifestation of negative feelings such as anxiety. It can also lead to the individual displaying avoidance behaviours which, in turn, only lead to further increased levels of disability, disuse and depression.

Eventually, the person will physically stop doing things because they have inflated their pain to such a level that they truly believe they can’t perform certain activities. This impedes on the provision of care, as individuals who catastrophise pain will often not adhere to treatment plans due to anxiety and avoidance. This is where certain treatments, such as cognitive behaviour therapy, are needed to try to train the individual to change their thought patterns and behaviours. Although many of these patients know they should be doing their physiotherapy exercises, they don't do them because they are fearful of causing themselves further injury and pain.

Social Stigma

Chronic pain is also associated with stigma related to the perception that the individual isn’t strong enough to cope with the pain. This leads to impatience and a belief that the individual should be doing better than what they are (McAllister 2015). Stigma can also keep the patient from seeking out treatment, as they fear that they will be perceived as not coping well enough with the pain, and being labelled a failure. An example of this is a situation in which an individual is being offered treatment to help them cope better with their pain; the individual may see this offer of help as proof that they aren’t coping with the pain as well as they should be. The vicious cycle of feelings of shame, guilt and worthlessness is then repeated. As nurses, we must be aware of this stigma and support the individual in overcoming negative attitudes towards their condition.

Health Professionals and Chronic Pain

Individuals with chronic pain are often poorly treated by health professionals. This is often due to inadequate education on pain management, and inaccurate attitudes and beliefs regarding chronic pain (Prem et al. 2011). This can result in nurses estimating a patient’s pain and being biased with their pain levels. We need to critically analyse how we care for individuals with chronic pain, be aware of these barriers and ensure they are not present during our care.

To ensure we address a patient’s pain effectively and decrease the potential for further negative effects, we need to control the individual's pain. Not cure it, but control it. We need to address any concerns that the patient may have about their psychological and emotional state, and ensure treatment provided to them is holistic. Often, this treatment will involve a multidisciplinary team including physiotherapists, occupational therapists and psychologists. Pain management programs are also beneficial as they encourage patients to actively participate in their treatment, increasing their autonomy, and allow them to take more responsibility for their pain (Van Huet et al. 2013). Chronic pain affects all areas of an individual’s health, therefore, our care plan for the individual needs to reflect this.

References

Block, C & Cianfrini, L 2013, 'Neuropsychological and Neuroanatomical Sequelae of Chronic Non-malignant Pain and Opoid Analgesia', NeuroRehabilitation, vol. 33 no. 2, 343-366, viewed 6 November 2020, https://www.researchgate.net/publication/235708879_Neuropsychological_and_neuroanatomical_sequelae_of_chronic_non-malignant_pain_and_opioid_analgesia
Institute of Medicine 2011, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, National Academies Press, viewed 6 November 2020, https://books.google.com.au/books?id=rTTRy1sjs3QC
McAllister, M J 2015, Understanding Chronic Pain, Institute for Chronic Pain, viewed 6 November 2020, https://www.instituteforchronicpain.org/understanding-chronic-pain/complications/social-stigma
Prem, V, Karvannan, H, Chakravarthy, R D, Binukumar, B, Jaykumar, S & Kumar, S P 2011, 'Attitudes and Beliefs About Chronic Pain Among Nurses – Biomedical or Behavioral? A Cross-sectional Survey', Indian Journal of Palliative Care, vol. 17 no. 3, 227-234, viewed 6 November 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276821/
Salazar, A, Duenas, M, Mico, J A, Ojeda, B, Agüera-Ortiz, L, Cervilla, J A & Failde, I 2013, 'Undiagnosed Mood Disorders and Sleep Disturbance in Primary Care Patients With Chronic Muscuoskeletal Pain, Pain Medicine, vol. 14 no. 9, 1416-1425, viewed 6 November 2020 https://pubmed.ncbi.nlm.nih.gov/23742219/
Turner-Cobb, J M, Michalaki, M & Osborn, M 2015, 'Self-conscious Emotions in Patients Suffering From Chronic Musculoskeletal Pain: A Brief Report', Psychology & Health, vol. 30 no. 4, 495-501, viewed 6 November 2020, https://pubmed.ncbi.nlm.nih.gov/25420522/
Van Huet, H, Innes, E & Stancliffe, R 2013, 'Occupational Therapists Perspectives of Factors Influencing Chronic Pain Management', Australian Occupational Therapy Journal, vol. 60 no. 1, 56-65, viewed 6 November 2020, https://pubmed.ncbi.nlm.nih.gov/23414190/

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