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The Diagnosis and Psychophysiological Management of Chronic Pain and Anxiety

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Clinical Behavioral Medicine

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Abstract

There is a growing awareness that the parameters of acute and chronic pain vary widely. Acute pain is easy to localize and recognize, and may, in fact, be mediated through different pathways from chronic pain (Sweet, 1981). These pathways include the (a) dorsal-column post synaptic system (DCPS), (b) spinocervical tract (SCT) and (c) neospinothalamic tract (NSTT), which are all rapidly conducting systems suited to convey phasic information (Melzack & Dennis, 1978). Acute pain is marked by an increase in mytonia, heart rate, blood pressure, skin conductance, and peripheral vasoconstriction together with other indicators of sympathetic activation. From a psychological or behavioral viewpoint we are seeing the same signs that indicate fear or anxiety. Chronic pain has been defined as any pain that has persisted for over 6 months and has not responded to standard medical management, including drugs, physical therapy, and surgery (Sternbach, 1974). Bonica, a pioneer in the study and therapy of chronic pain, defines it as “pain which persists beyond the usual course of an acute disease or a reasonable time for an injury to heal, or it recurs at intervals of months or years (Bonica, 1980). Studies by Johnson (1978) and Barton, Haight, Marsland, and Temple (1976) reveal that 75% of patients who complain of recent onset back pain experience spontaneous remission within 3 months.

In many patients, chronic pain, I suspect, is an illness generated by interpersonal or social factors and is only distantly related to acute pain. It should not surprise us, then, that those therapies most effective for acute pain, such as rest or narcotics or neuro-muscular relaxants, are, in fact, detrimental to the chronic pain patient... I believe that the problems of chronic pain can only be solved if an approach to human illness broader than the biomedical model is developed by both researchers and clinicians.

—John D. Loeser, M.D. Professor of Neurosurgery University of Washington, 1980

Pain syndrome patients, in their desperate search for the elusive cure, often chase “windmills” and convince their doctors to perform a myriad of invasive tests and procedures. As a result of their pain behaviors, many experience iatrogenic complications, suffering, and disability.

—Gerald M. Aronoff, M.D. Editor, The Clinical Journal of Pain, 1985

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  1. Behavioral Medicine Clinic and Stress Disorders Research Laboratory, Eastern Virginia Medical School, Norfolk, Virginia, USA

    Ian E. Wickramasekera Ph.D. (Professor of Psychiatry and Behavioral Sciences, Director)

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  1. Ian E. Wickramasekera Ph.D.
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Wickramasekera, I.E. (1988). The Diagnosis and Psychophysiological Management of Chronic Pain and Anxiety. In: Clinical Behavioral Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-9706-0_8

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