The Road Better Travelled?

Problem-wise, spousal relationships are at very least peppered with disagreement. In couples counselling, rather than a face-off, the focus mainly is, and should be on the relationship and what may be changed, added, or removed, in order to ameliorate it. The alternative, the ‘clash of perceptions scenario,’ sets the stage where both parties get to simmer under the microscope if not wince under the whip.

?Similarly, inter-generational discussions are way more productive when dispensing with the usual dyad of then vs. now in terms of perceived quality or value. A more fruitful approach would be that of fellow soul-travellers of different vintage, ambling along hoping to figure out a more fulfilling and less corrosive life path. This not only generates insights, but can also elicit empathy.

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The outcomes of chronic diseases do not at all match those of most acute diseases in terms of success. This issue is best addressed by educating and helping alter the patient’s relationship with their condition.

?In acute or sudden onset disease, also usually of short(er) duration, the requirement is prompt medical attention. Broadly speaking, here the analogy for the relationship of patient to disease is more often that of a hostile visitation or an invader. This may be a microbial infection, trauma, certain vascular events, acute allergic reactions, and other episodic non chronic situations. This is usually treated by medication, surgery, rest, possibly other adjunct therapies, and in the end the ‘intrusion’ is staved off and recovery is achieved.

?In chronic pain ... they should aim at functionality and self- efficacy at every turn, even if that may initially mean more pain.

Chronic diseases of course are slower in onset, and persist for longer, sometimes over a lifetime, despite ongoing medical therapy. In this category, lifestyle adjustments are essential for improvement and preventing complications rather than anticipating a rapid resolution by outsourcing all the treatment efforts to therapists.

?However, too often from the patient’s standpoint, the expectation remains for the chronic disease outcome to mimic that of an acute disease, in terms of duration and success, the patient seemingly oblivious of their backstory. How many patients truly understand the formidable functional reserve that most organs have before producing symptoms or even abnormal laboratory tests when dealing with chronic disease? Not knowing leaves too many feeling that their dis-ease only started around the time they received a definitive diagnosis.

?In chronic disease, the challenge is more of an imbalance, or loss of homeostasis and the approach should be akin to rebuilding and strengthening, closing the gaps and ‘putting out fires’ rather than staving off an attack. The problems arise from within, structural and functional deterioration as a consequence of one’s lifestyle, behavioral choices, and even ideas about what is wrong, as all of these have a profound influence on disease and recovery.

?The key to daily and protracted health is moderation. This favorable spectrum (as opposed to ‘sweet spot’) is a health promoting and life sustaining zone–as any behavioral and lifestyle overindulgence coupled with a paucity of adaptive behaviours and thinking patterns presents a challenge to homeostasis.

In chronic pain the difficulty is persuading someone that despite their daily pain they should aim at functionality and self- efficacy at every turn, even if that may initially mean more pain. This is rarely easy, which is why so many remain pre-contemplative for extended periods about accepting this information. When something hurts badly, one tends to use it far less often and sometimes coddle it. Studies, however, show that longer term moderate exercise can lessen moderate to severe chronic pain which interestingly includes cancer pain.

?Medication and injection therapies may reduce the pain experience but will not address the pathology.

An extreme and extended pain focus, and the predictable maladaptive behaviors that follow (hypervigilance, fear avoidance and several others) as well as the cessation of everyday helpful behaviors, together with unhelpful thinking patterns drags one into chronic pain. Even one’s own negative self-perceptions and judgments, given the ability of human consciousness to reflect upon itself, tends to keep one stuck.

?The way forward is to over time shift focus towards physical and social activation and quality of life that help address the neuroplastic changes that have occurred on a bio-behavioral basis (learned behavior) and return to more adaptive behaviors and thinking patterns. This basically constitutes a recapture, as far as possible, of one’s pre-morbid functioning. Medication and injection therapies may reduce the pain experience but will not address the pathology.

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Do animals in the wild suffer from chronic pain?

?Those that reach advanced age are probably plagued by episodic pain and discomfort such as degenerative joint conditions.

?With regard to chronic pain progression as seen in humans post- injury (or post- surgery/disease), we don't really know, but it is reasonable conjecture to believe that they may well not, given that there is no biological or evolutionary value in chronic pain, the initial injury having taken place and recovery, as far as possible, having already been achieved.

?While the injury may place the animal at severe risk of survival, they presumably continue doing what they can, as their environment doesn’t even vaguely support any withdrawal from life.

?#chronicdiseasetreatment ?#chronicpain ?#self-efficacy

www.trevorcampbellmd.com

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