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Re: Psychological problems are the cause of chronic pain??? Dr. Whitfield, your comment please.

Re: Psychological problems are the cause of chronic pain??? Dr. Whitfield, your comment please.

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Posted by MLWhitworth, MD on April 12, 2000 at 19:17:03:

In Reply to: Psychological problems are the cause of chronic pain??? Dr. Whitfield, your comment please. posted by ila on April 12, 2000 at 08:42:43:

I understand the dilemma you are placed in because of chronic pain. While it is true that most patients who exist with chronic pain have strong psychologic stressors from their past and present, there is not a shred of evidence that chronic pain is initially caused by the presence of these stressors. It is however true that the defence mechanisms in these patients have been compromised and the coping abilities are poor. Does this mean because chronic pain may be maintained by psychologic phenominon that they have no physical pain generators? Of course not. The vast majority of patients in chronic pain have psych problems secondary to the chronic pain, not chronic pain secondary to the psych problems. It is a cop out to say because we do not know what the pain generators are, or how they are modified by the psyche, that a person is merely faking it or has no "real" pain. From the brain's standpoint, pain is pain. For many years patients have been told there is nothing wrong with them or that it is all psychological, but chronic pain rarely begins as a primary psychiatric disorder. If that were true, then why aren't the millions of manic depressives or schizophrenics developing spontaneous chronic pain. No, this does not occur. But it is true that our cultures, past pain experiences, and the psychologic state modify pain and can intensify it. Anger, hostility, depression, anxiety, and sleep disturbances are all known to be potent modifiers of pain. While they do not in and of themselves create the pain, they do make it worse. That is why pain docs often will try to address these other areas to minimize these amplifying influences on chronic pain. It is also useful to incorporate certain psychologic modalities such as cognative therapy, biofeedback, etc. in chronic pain- not to eliminate but to reduce chronic pain perception.
Hope this helps.

: Hello fellow chronic pain sufferers, hope this post finds you all in the best of health and also in good spirits.

: Here's a question to whoever reads this post.

: While talking about depression to my physio, as a result of c.p., I was questioning the validity of quotes made to me by various Doctors on why c.p. happens and to whom it happens to.

: We also discussed her "I can tell if you're faking it" statement - I asked her how she knew I wasn't a fake, and that maybe I really wasn't in chronic pain, but she didn't know.

: The physio said that it was a documented fact that the majority of people in chronic pain were in that pain because of factors other than the physical.

: "Other than the physical" included people living in bad marriages, domestic violence, including psychological relationships, people who were physically abused as children, people who were depressed etc.

: She also stated that these very same people were prone to drug abuse and addiction.

: When a person is injured, does the brain tell the injury to manifest itself all over the immediate region of the body to ensure chronic pain is suffered?

: Is the brain capable of this form of deceit??

: Is this true??

: To my mind, this thought process is extremely denigrating to all those in chronic pain.

: In my case, it made me feel as though I were a fake, even though she assured me I was not in that particular group. I asked her "how do you know that".

: She said she did. Supposedly, the body is able to tell specialists in this field that a person is faking it.

: If that is so, why do they say "the majority of people in chronic pain are fakes". Her answer to this was "the person didn't know their pain was the result of their psychological hurt. They truly believed their body was in pain".

: That, I am told, is why many specialists prescribe anti depressant drugs, advising sufferers to seek psychological assistance.

: Here is a statement made by the pain manager I recently consulted with.

: He asked what happened after my attendance at a chronic pain clinic I'd been to. I told him that although I still suffered a lot of pain after the clinic, I enjoyed the information received there as I previously had not known a lot of it.

: Also, I said that pain had been moving in a different pattern, but after the clinic, pain intensified and moved to cover a larger area of my body.

: He said that my mind had been "opened up" to new possibilities of pain referral by the clinic. As a result, pain "appeared" to the places I pointed out.

: When I told him he was wrong because - previous to attendance, pain had been "in and out" of these regions anyway, the pain moved into a different "pattern" - meaning burn and sharp/knife pains with pin pricks around neck etc. intensified etc., he said "oh yes, but your mind was also
: directing"what was going to happen".

: Luckily, I keep a diary. Pain actions were contrary to his statements. But he's written them in a report so they will now be taken as fact - or will they?.

: In making these statements, was he telling me my mind alone had directed all pains to go to the regions they did, to manifest in the manner they did and to stay in said regions to get worse??

: I have read articles in New Scientist and other magazines. By reading these magazines, am I opening up the possibilities of chronic pain occurrences in my body??

: "I might add that before I read these articles, whatever pains I have are already there". BUT what are these articles and various specialists/Doctors saying -in laymans terms??

: If I am not "in that group", who is??

: I live and breath chronic pain. To my knowledge, I am not in control here.

: When I get angry, I am able to do jobs around the home with pain at a minimum. When I have finished these jobs and my anger has dissipated, the pain comes on in waves of absolutely excruciating pain.

: Does this mean my pain is psychological ? Supposedly not!!

: I've read articles (New Scientist etc.) on chronic pain. A lot of them link pain to the brain.

: Regardless, who says whose pain is real or fake??
: If Dr's who are in control of a patient suffering from c.p. believe this statement treat the person as a fake until they are seen by a specialist who advises to the contrary, endanger the Is this negligence??

: If the Doctors believe this, why should they refer this patient on. Why not just treat them minimally until they go away?

: If this is the normal practice, shouldn't all people who suffer from chronic pain for longer than a specified period of time (2 mths or so) be referred to a specialist in chronic pain, and no-one less than?

: Also, should a psychiatrist be brought in immediately to assess the

: What is meant by "the person doesn't know they are generating their own pain"? How can the mind be that powerful that it could hurt it's owner in that manner?

: If people had a terrible childhood or were in a violent relationship etc, but overcame their past to live in harmony, then were afflicted with c.p., would they still be housed in the category of the so called fake??

: How do they know?????

: This whole argument is extremely disquieting to me. I know my body is in extreme pain, I try to tell it that it isn't. It answers me back emphatically. Am I or aren't I, will I or won't I.

: No matter what the physio tells me, I now think to the contrary.

: I wonder why my GP won't act appropriately on my behalf, thinking he thinks I'm not really in chronic pain.

: This in itself does nothing for my self esteem and confidence.

: Previous to injury, nothing could hold me back. I could do anything, anytime! They then say c.p.ers were in chronic pain before the pain. I know that this statement is definitely false.

: Chronic pain generates depression!

: Dr. Whitfield - how do you answer this?

: Even when I see the specialists I'm hoping to see, those thoughts will linger in the back of my brain. What does one do??

: Why does everything have to be categorised? Why does anyone have to be a fake in chronic pain?

: Pain is pain - isn't it????


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