The particular properties of chronic pain versus acute pain.
Anyone with chronic pain and anyone who lives with someone with chronic pain quickly learns the peculiarities and far-reaching consequences of chronic pain.
Acute pain is most often localised and has a clear relationship with a cause and is limited in duration. Fixing the cause usually ensures that the pain disappears without negative lasting effects. Moreover, the intensity of the pain is often easy to explain, depending on the cause and location. This is the pain we all know, but all these characteristics of pain seem to change when the pain is chronic.
More factors in chronic pain
Apart from the pain itself, which no longer seems to behave “rationally” in terms of intensity and location, all sorts of new factors are implicated in chronic pain.
In the case of a broken arm, it is understood that the person is unable to perform certain tasks, but in the case of chronic pain it is much less clear to describe and also less easy to understand.
Effects such as long-term dysfunction in the work environment have psychological consequences; these psychological consequences of social problems are called psychosocial factors.
Thus, in an attempt to better understand and treat chronic pain, the model of “total suffering” has emerged.
Let us consider six aspects that may play a role: physical suffering, social problems, psychosocial consequences, cultural norms and values, intellectual needs and spiritual needs.
An example of the six factors of total suffering:
Inability to exercise (Physical). Economic concerns due to pain (Social). Feeling guilty for not being able to work (Psychosocial). Social institutions refusing to pay (Cultural norms). No longer being able to maintain the same relationships (Intellectual). Thinking that pain is an ordeal that has to be endured. (Spiritual)
In addition, the possibilities of pharmacotherapy, to reduce the feeling of pain in the case of chronic pain is often only partially possible because the pain medication itself cause complications). Hence, other solutions will have to be found to reduce the “total” suffering.
Unique individual picture
It is already clear from the example that chronic pain will create a unique constellation for each patient. No one has the same economic, social, intellectual and spiritual circumstances, so everyone has a unique way of suffering.
It will therefore be an individual challenge for every patient with chronic pain to cope with the new limitations and possibilities. It will be an even greater challenge if the intention is to interpret changing circumstances in a positive way and see them as a new and unique opportunity to do something special in your own life.
An intellectual challenge
In my method I emphasise the intellectual challenge. I start from the idea that the mind enables us to understand the physical, social, economic and cultural conditions and thus, to a certain extent, to accept them as factors that escape our own responsibility. In the social sciences it is assumed that at least sixty percent of our lives are determined by factors outside ourselves. What remains is the margin within which we can change our circumstances.
Our intellect is the instrument par excellence to analyse and understand the possibilities, to know and recognise our own capacities and to develop a viable strategy and to constantly assess and adjust it if necessary.
In life it is like playing chess, we sometimes have to play bad positions, see where it is possible to keep the game going and appreciate the beauty of a good defence.
Our mind is also the only instrument of our body to counteract the centripetal force of pain. Pain focuses on ourselves. It originated as a physiological necessity for the survival of the individual in primitive circumstances. In chronic pain in which everything has been done to support physical health as well as possible, the pain no longer has any constructive meaning.
Under extreme circumstances, such as in fight or flight situations, pain is not felt. But under normal circumstances it is very difficult to ignore pain. Only our intellect is able to create an inner world that can form a counterbalance; a world of experience that can hold our attention in such a way that there is less attention for the pain.
The role of a therapeutic relationship
A therapeutic relationship is a “rehearsal” relationship. It is not a relationship in the true personal or social sense of the word. Outside the therapy space, the relationship does not exist, and all that is discussed within the therapeutic circumstances is merely an exercise to build new relationships in life, or to make constructive changes to existing relationships.
In the case of chronic pain, therapy is not a pain treatment in the strict sense of the word. On the other hand, it is of enormous value for the patient with chronic pain to create a personal world “around” the pain.
It is also in this strategy that the theory of the extended mind, our mental hold in the world, is a great contribution to help the chronic pain patient on his way. Together with embodiment techniques – learning to find resting points in the body itself – and the intelligent construction of the extended mind, the therapy can form a constructive framework to learn to live with chronic pain in a dignified way on a daily basis with the prospect of personal development like everyone else.
Frida Kahlo, Tree of Hope, 1946. Museum of Contemporary Art, Chicago.