A multi-modular approach to treating back pain and fibromyalgy, taking into consideration psycho-social factors.

“Chronic pain is not usual pain that simply has a greater duration; it has another quality to it. With chronic pain one has gone beyond the kind of pain that can be forgotten and it becomes one with which one lives constantly...”.¹

With these words of Hans Saner, a Swiss philosopher, I wish to present various thoughts on the theme of “Dealing with Pain”. Chronic pain is not only a medical problem. At its core is suffering and the patient’s individual experience of the illness. To gain some influence over this pain it is both necessary and helpful to elicit interdisciplinary cooperation in many areas, such as medicine, psychology, physiotherapy and ergo-therapy, as well as politics, sociology, anthropology and philosophy.

In medicine, as well as in rheumatology, we find ourselves in a phase of paradigmatic change. We are moving from a mono-causal, linear, dualistic and pathology-centred concept of illness and treatment (the thesis), to a multi-facited, holistic and salutogenetic approach (the anti-thesis). Only in the future will we know what the synthesis of this dialectical process will be.

In contrast to the old biochemical model, the “new” bio-psycho-social system that had its inception in “gate control theory” of R. Melzack and P. Wall² is based upon an interrelatedness of somatic, psychic, social and cultural factors. Influences from both the inner and outer realities of patients have an impact upon the strength of pain, the quality of pain and the worsening of chronic pain.

While continuing to respect the dignity of their patients, research and treatment specialists are beginning to interest themselves in the patient’s behaviour as well as in their emotional and cognitive reactions to their pain. Research has shown that the following areas are meaningful for a successful rehabilitation: characteristics of the origin and the controlling of pain (cause attribution, locus of control), individual experiences of the illness, cognitive and emotional reactions, coping strategies and influences of variables in the surrounding environment (interactive and structural). Under no circumstance should these observations allow one to ignore other areas under consideration. Specifically, these areas include somatic manifestations, daily stress and work stress. Positive and negative coping strategies will be briefly illustrated in the lecture. The following concepts will be clarified as well: characteristics of the origin of pain (cause attribution), characteristic of the controlling of pain (locus of control), individual illness experiences and the cognitive and emotional reactions to pain.

References

1. Saner H. Die Anarchie der Stille. Lenos, 1990

2. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965