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Treatment Variances for Acute and Chronic Pain

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Treatment Variances for Acute and Chronic Pain

Pain is such a costly and agonizing affliction, so why is it so difficult to treat pain effectively? Almost everyone experiences pain at some point in their lives. Pain is not only unpleasant, but it is one of the most expensive maladies for health care, income, and productivity. In the United States alone, back pain accounts for five billion lost in the health care industry (Bellenir, 2002). Whereas there is minimal information on how humans perceive and sense pain, there are theories and explanations on different types of pain and treatments to manage pain. According to Russo (2001), "It is easier to treat acute pain than chronic pain because chronic pain can lead to maladaptive behaviour" (Encyclopedia of Life Sciences). It is necessary to understand the psychological factors that contribute to an individual's perception of pain to treat acute and chronic pain effectively. The successful treatment of pain will lead to physiological and emotional wellness that enhances the quality of the individual's life.

Craig and Sorkin (2005) define pain as " unpleasant sensory and emotional experience..." (Encyclopedia of Life Sciences). Although pain is discomforting, it contributes to and acts as a defense mechanism. Pain acts as a warning sign to let one know there is something wrong; an individual experiencing pain from placing their hand over flames will sense the potential harm. Pain also helps one learn through experience. An individual who experiences pain from putting their hand over flames learns not to repeat his or her actions in the future. Pain alerts humans to external factors in the environment that could potentially cause harm, but it also alerts humans when something is wrong internally.

Two different types of pain are acute pain and chronic pain. A laceration, appendicitis, or torn muscles are considered examples of acute pain. Even though pain may be agonizing at first, the body can heal itself or receive treatment from analgesics to gain relief from pain. Analgesics are medications that alleviate pain by interacting with neurotransmitters in the central and peripheral nervous system (Craig & Sorkin, 2005). Acute pain is less challenging to treat because it is short in duration, and the cause is identifiable. Chronic pain is described as pain that is persistent for more than six months. Chronic pain is persistent and may take several weeks, months, or even years to diminish. Analgesics alone are not an effective treatment for chronic pain; a combination of pharmacological as well as non-pharmacological methods such as psychological intervention is the most effective approach to manage chronic pain; rehabilitation along with education is also integrated into the treatment of pain (Russo, 2001).

In the past few decades scientists have learned that chemicals in neurotransmitters play a key role in pain processing. Neurons have extended fibers called dendrites that come close to another neuron's axon terminal. The dendrites releases chemicals called neurotransmitters onto the next neurons axon terminal. The neurotransmitter either excites the neuron and makes it fire, or inhibits it from firing and generates a signal. The constant firing of the neurons is one reason some individuals feel constant pain.

Researchers found that humans are capable of inhibiting pain signals. Some studies led to the discovery of brain chemicals that have the same effects as morphine. Scientists were able to prove that during painful stimulation, the body releases endorphins to soothe the nerve cells. There are many psychosocial considerations that will affect an individual's perception of pain.

Gender is one factor to consider when treating pain. Researchers have discovered that males and females not only perceive pain differently, but they also react differently to treatment. There are differences in central pain processing between genders. In fact, the use of positron emission tomography (PET) has proven that females show an increased physiological response to pain when compared to males. In one study, researchers took skin samples and discovered that females have twice the nerve fiber density compared to that of males. The differences in the structure of the nervous system between genders explain the contrast in pain perception between genders.

Females are more likely to pursue treatment for pain compared to men; cultural and psychosocial factors are believed to contribute to the inconsistent response to pain between genders (Paller, Campbell, Edwards, & Dobs, 2009). Some researchers hypothesize that this could be related to childhood sexual abuse. In fact, 27% of females compared to 16% of males reported abuse during childhood according to one national study; childhood abuse is associated with a higher rate of pain disorders as adults (Paller et al., 2009). Culture also impacts the gender-related differences in pain perception. Girls are often coddled as children when they express pain, and boys are often expected not to cry when expressing pain. These differences in the reinforcement of pain response in males and females as children can also affect pain perception.

Females are more likely than males to catastrophize pain. Catastrophizing is a negative psychological response to pain that includes feelings of helplessness, perseveration of negative thoughts, and exacerbation (Paller et al, 2009). This behavior is associated with an enhanced perception of pain and a delayed or reduced response to treatment. Individuals who display positive thoughts and behaviors have an increased response to treatment and a reduced level of pain. One study on menstrual pain intensity revealed those women who are high pain catastrophizers reported greater menstrual pain and less relief with medication; whereas women who are low pain catastrophizers found greater pain relief through medications (Walsh, LeBlanc & McGrath, 2003). Researchers have determined that males use behavioral distractions to cope with pain while females rely upon social supports and positive self-talk (Paller et al, 2009). Given this research, psychological interventions could have a positive effect on the treatment of pain in females in conjunction with pharmacological analgesics.

Psychology plays a significant role in the treatment and managing of various causes of pain, whether that pain is emotional or physical. An understanding of the various personality types and disorders will be helpful when treating pain in these patients. For example, individuals who have borderline personality disorder (BPD) in conjunction with self-injurious behavior (SIB) have a higher threshold to tolerate pain compared to individuals who do not engage in SIB. Research suggests that individuals



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