Model of Chronic Pain
What is pain and how does it help us?
If we were to look at a definition we would read:
1. highly unpleasant physical sensation caused by illness or injury.
2. mental suffering or distress.
This may also have components, short (“acute”) vs medium or long term or type of pain which may be viewed as “chronic”. Pain may come or go and therefore be referred to a “recurrent” or intermittent” but in all these cases it is a signal. It is body’s way of telling us that something it not quite right and that we should pay attention to that signal.
In the case of a broken leg, the message is loud and clear - we need to stop and seek urgent medical aid. However, that message become less clear when we have an intermittent chronic component such as in the case of lower back pain. For many of us, the inclination would be to stop doing anything that aggravates the pain. However, the persistent pain signal maybe serving no useful purpose and, over time, may affect our ability to work or sleep.
There is no doubt there is a physical component to pain which involves the signal traveling through the spinal cord and specialised nerve fibres to our brain. These fibres throughout our body also rapidly process the pain signals much like a computer. However, these signals can get scrambled leading to the brain misinterpreting what it is receiving, particularly in the case of chronic pain. These messages feed into the emotional parts of our brain leading creating a pain cycle – the more anxious / angrier / depressed we are, the more sensitive, less able to cope
Pain Scale
This greater understanding of pain has led to the development of the biopsychosocial approach to pain management. Nociception is the physiological component from the nerve receptors while pain is the resulting subjective perception. This can differ hugely between individuals (see pain scale) depending on their tolerance and understanding of what pain is.
Loeser’s Model of Pain Behaviour
Suffering and pain behaviour can be described as reactions to those signals and can be dependent on cause, who was responsible, previous injury history and implications such as lack of activity or loss of independence. This leads to possible emotional responses of depression, anxiety and fear. Therefore, biopsychosocial approach to the pain experience infers that it should be viewed from a systematic perspective so as the physical symptoms worsen, the psychological and social factors follow and need to be managed.
Through this approach and by understanding and treating us as a whole person, if we are suffering from chronic pain, we are far more likely to regain physical function and to show vast improvements in our quality of life.