Research has established a positive association between appraisals of control over pain and indexes of adaptive psychologic and physical functioning among persons with chronic pain. A number of measures of control appraisals have been used in the research literature. The current study sought to determine the number of factors or dimensions embedded in these commonly used measures of pain control appraisal. The study also sought to determine the association between the control appraisal construct(s) and measures of patient functioning. Two hundred fifty-two persons with chronic pain completed a questionnaire packet that included multiple measures of control appraisals. A factor analysis resulted in 6 factors: 1 factor representing beliefs about control over life in general, 1 representing perceived control over the effects of pain on one's life, and remaining 4 factors that appear to be more closely tied to perceived control over pain itself. Consistent with previous research, control appraisals made a significant contribution to the prediction of functioning (depression, disability, and pain interference). Most importantly, perceived control over the effects of pain on one's life and perceived control over life in general were more strongly associated with functioning than perceptions of control over pain itself.
"Role of multidisciplinary team (MDT): Evidence for adaptability of subjective responses to learning and experience, provides encouragement for evolving systems with MDT inputs for emotional and social support throughout the management plan. An ideal system would integrate appropriate and timely inputs from the nurse, physiotherapist, psychotherapist, occupational therapist, yoga therapist, social worker, and family/community carer along with the pain physician. "
[Show abstract][Hide abstract] ABSTRACT: The field of pain medicine that once began as a supportive and compassionate care, adding value to the management of acute and chronic ailments, has now transformed into a vital and essential specialty with structured training programs and service units with professionals dedicating their careers to it. The expansion of understanding of the direct relationship of pain relief to the quality of life, uncovering of neuronal pathways, and technological advances in imaging as well as in interventional techniques have all contributed to this phenomenal growth. However, there is a growing concern whether the training programs and the specialized practitioners are gradually limiting their skilled inputs primarily within the sensory realm of the pain experience with sophisticated interventional techniques and relegating its subjective and emotional dimensions to perfunctory realms within the schema of service provision. While the specialty is still young, if we can understand the inherent aspect of these dimensions within the pain experience and acknowledge the gaps in service provision, it may be possible to champion development of truly comprehensive pain relief programs that responds effectively and ethically to a patient's felt needs. This article attempts to position the subjectivity of pain experience in context and surface the need to design complete systems of pain relief services inclusive of this dimension. It presents authors' review of literature on perspectives of 'unpleasant subjective emotional experiencing of the pain" to elucidate possible clinical implications based on the evidences presented on neuro-biology and neuro-psychology of the pain experience; the aim being to inspire systems of care where this dimension is sufficiently evaluated and managed.
Indian Journal of Palliative Care 03/2013; 19(1):12-9. DOI:10.4103/0973-1075.110217
"For example, relaxation may control both one's pain and the impact of pain on one's life. Regardless, though, as Tan et al. (2002) demonstrated, perceived control over the effects of pain was more strongly related to better adjustment and less disability than perceived control over pain itself. McCracken et al. (2004) proposed that the ineffective struggle to gain control over pain that is essentially uncontrollable should be abandoned, and that acceptance of pain may foster the sense of general life control. "
[Show abstract][Hide abstract] ABSTRACT: The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.
"control pain may be especially unhelpful in the context of pain experiences that are particularly intense (Jensen and Karoly, 1991). Perceived control over effects of pain on life functioning is more strongly associated with functioning than perceived control over pain itself (Tan et al., 2003). Other data show that patients who report greater struggling to control pain also report greater pain, distress, and disability (McCracken et al., under review). "
[Show abstract][Hide abstract] ABSTRACT: Research and clinical developments over the past 20 years are beginning to shed new light on thoughts, sensations, emotions, their role in influencing behavior, and the particular ways in which private experiences contribute to human suffering (e.g. Hayes et al., 2001). This has led to different approaches to treating a broad array of behavior problems, approaches that incorporate a partnership of acceptance and change. We have defined acceptance of chronic pain as an active willingness to engage in meaningful activities in life regardless of pain-related sensations, thoughts, and other related feelings that might otherwise hinder that engagement. It is about not engaging in unnecessary struggles with private experiences, struggles that often intensify the aversiveness of those experiences and enhance their life disrupting influences. What is novel about this approach is that it is not simply a new psychological variable but a description of a different set of processes of pain and suffering. This approach is fully situated within the broader empirical tradition of the behavioral and cognitive therapies. The examination of its potential merits is already underway.
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