The Dark Side of Pain

THE DARK SIDE OF PAIN

The Dark Side of Pain University of Miami Comprehensive Pain and Rehabilitation Center by Renée Steele Rosomoff MBA, RN, CRRN, CRC, CDMS  The consequences of persistent intractable pain can be cruel. The depth of suffering is Immeasurable and is unique to the person experiencing the pain. It can be a lonely struggle and a place where even loved ones cannot travel. When significant others or healthcare providers cannot adequately alleviate the suffering or its source, they may become deafened or oblivious to the pain sufferer‘s "silent scream" for help. As the pain persists, the sufferer descends into the vortex of more pain and misery. They struggle to maintain some semblance of who they used to be, for fear they will be less lovable and less loved. If the pain continues, it will erode even the strongest of spirits and the sufferer will succumb to withdrawal and social isolation. They will become intensely preoccupied with self and unable to function as a member of the family unit or of society. Once they have run the gamut of physicians, surgeons, and other failed treatments and the pain persists, they will seek the solace of alcohol, drugs (prescription or street drugs), or even turn to quackery for pain relief. When desperate enough some in anger will commit homicide or the ultimate act of desperation-suicide! The patients seen in pain treatment centers like ours or in other practice settings are in chronic pain, physically impaired, weak, and deconditioned. They are often drug and/or alcohol dependent, hostile, untrusting, frightened, helpless, hopeless, and socially dependent. They may have marital problems, sexual difficulties; suffer from anxiety, anger, or depression. They often have no job and face severe financial problems. Many have had years of failed treatment and multiple surgeries -in our experience, as many as thirty-two surgical procedures to the low back. Surely these patients are a challenge to any professional. We who treat pain patients must be aware of the "mind-body" connection, or we will fail miserably. We must treat the total patient in a balanced manner. While we may understand the anatomy and physiology of pain in great depth, we must understand and help the person who has the pain. These complex patients must have a comprehensive physical and behavioral treatment approach carried out in a concurrent and integrated manner if we are to succeed in helping them. To achieve this, Psychologists must be equal partners on pain treatment teams. They must be involved with patients to deal with the lack of trust and other behavioral consequences of persistent, prolonged pain in order for the medical treatment plan to be accepted and subsequently most effective. Psychologists have the knowledge and expertise so often needed to make the difference between failure and a successful outcome. Their skills ‘in such areas as behavior modification, biofeedback, and relaxation can often help lead the pain sufferer from the brink of despair to wellness. When the suffering or behavioral component is ignored and the physical substrate cannot be readily identified, too often patients are labeled as interested *in secondary gains, as hysterics, as malingers, or having purely psychogenic pain. Yet there is no scientific evidence to support these contentions. What a great injustice to be so identified! Certainly it is one we would not want perpetrated on us. We must avoid labeling patients in such a pejorative manner simply because we lack sufficient knowledge to diagnose and treat their problems. The consequences of doing so are manifold: 1) Rejection of the pain sufferer as a valid human being. 2) Rejection of the patient by payers of future benefits or medical treatment, which might be of help. 3) Rejection by loved ones that feel they have been duped by the pain sufferer. 4) Anger of the patient and loved ones against those they trusted to help them. 5) Rejection by the patient‘s employer in regards to motivation to return to work and the potential loss of future employment/career. 6) Stigmatization of the patient with a psychiatric diagnosis Pain sufferer questions his/her own sanity. All disciplines must recognize the constraints of their training and the parameters of their expertise. Psychologists must acknowledge the importance of the physician and others needed to deal with the physical substrate. It is impossible to simply "talk" patients into pain relief. Conversely, physicians must understand that the physical findings are only the -tip of the iceberg" and to treat them exclusively can only lead to frustration and disaster. In summary, the mind-body connection is fully integrated and cannot be separated. Yet, the behavioral issues-like the dark side of the moon-are not readily seen. Therefore, the only rational approach is a balanced team approach. It would be egotistical and inconceivable for any one discipline to think it alone could successfully care for such patients. Nothing less than a multidisciplinary/interdisciplinary team of experts is indicated. It is unjust, immoral, and unethical to hold such patients in unidimensional or inappropriate treatment settings. To do so is to deny them the last opportunity to return to a productive, quality lifestyle, and to condemn them to the purgatory of pain and disability for the rest of their lives! University of Miami Comprehensive Pain and Rehabilitation Center, 600 Alton Road, Miami Beach, Florida 33139