Self-Regulation and Recovery

...the majority of patients are not receiving an adequate exposure to the psycho-social interventions and due diligence...

Results from a recent national health interview study (USA) showed that 27% of those with chronic pain used medications alone and that this group tended to be of low income, the elderly and the uninsured. After exercise, complementary therapies including massage, chiropractic treatments, meditation, and guided imagery also featured.

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The above suggests that the majority of patients are not receiving an adequate exposure to the psycho-social interventions and due diligence that international pain experts agree is essential treatment in order for recovery to occur.?

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The development of chronic pain involves learning mechanisms, memory, the emotions, and environment and hence there is a marked behavioural approach to bio- psychosocial treatment because of accessibility.

In medicine we always firstly try to remove the cause, where possible...

The neurological basis of the establishment of chronic pain is of course neuroplasticity- the brain’s ability to change itself structurally and functionally under certain conditions. Medication, injection therapies, physical therapies and many other widely used treatments may reduce pain for a limited time, and can increase functionality to a degree, but these are not aimed at reversing the cause. In medicine we firstly always try to remove the cause, where possible, although often we are unable to, settling instead for reducing the /deleterious effects of a disease.

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As the importance and gravitas of their psycho-social efforts and interventions are seldom fully understood by the patient, there is often suboptimal effort, inconsistent frequency, and lack of focus when it comes to the practice. An analogy would be the actions of someone keen to build up muscle but somewhat averse to or bored with gyms. They may try to fast-track by lifting weights inappropriately heavy for their physique, their coping mechanism being hastily completing three sets of ten using a less than helpful or even an unsafe technique (form). But once the important principle is explained that muscle is best built by time under tension, they may well slow down, focus more on form by using lighter weights, and become guided more by their mind, the ‘how’ (action) becoming clearer and more obvious, once the ‘why’ (reason) is fully understood.

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The chronic pain patient more often sees their attempts at psychosocial due diligence as something arbitrarily or even randomly prescribed, having little awareness and sometimes none at all about what is actually being targeted by their efforts, while they go through the motions. A strong sense of purpose is lacking even though their desire for recovery remains intense.

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Studies repeatedly show that interventions that are active, self-directed, and self- efficacious ensure superior health outcomes. The importance of this point can barely be overstated and is indispensable for buy-in, providing essential context and facilitating emotional engagement.

..."the secret of success is consistency of purpose."

Benjamin Disraeli opined that "the secret of success is consistency of purpose." Persistence and daily involvement in therapy are essential for recovery. Emotional and relationship triggers and aggravators of chronic pain can be countered by emotional hygiene, best learned through CBT.

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Regarding the behavioural side, this is at heart a return to what was and hence what is already known, namely the healthier aspects of one’s pre-morbid life, mostly the vital, adaptive and helpful activities of daily living. In physical rehabilitation programs, a graduated return to work is both the pinnacle and the crucible of a successful program.

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However sound this may be, there is the downside that the apparent banality as perceived by the patient may come across as ‘less than medical,’ and hence not compelling, given the severity and pan-intrusive nature of chronic pain.

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Equally important, a better patient understanding of recovery is mandatory. This consists of any combination of increased functionality, improved quality of life and pain reduction/elimination, the latter of which, while paramount to the patient, is unfortunately the last of the three to occur.

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#biopsychosocial?#behavioraltreament #meaninginpain

www.trevorcampbellmd.com

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