Many experts believe that, while the treatment of pain often includes prescribing
pain medication, the psychology of pain and coping with it are also key.
Dr Amanda Williams, a reader in clinical health psychology at University
College London, says: “If a Primary Care Physician (PCP) explains pain effectively to the individual with
pain, making clear that (after proper assessment) it is not a sign of actual or
imminent damage or disease, but that the pain system has ‘got stuck’ on the
pain message and the best thing to do is to try to work back towards a normal
range and amount of activity, then the longer term risks of chronic pain may well
be mitigated.
“But PCPs are in a difficult position, concerned not to miss the rarer but
possibly treatable serious problems, and unable to give convincing reassurance
that there is nothing seriously wrong until they’ve assured themselves of that.
That often means investigations, and just ordering those tends to push the
thinking of doctor and patient into the ‘something wrong to be discovered’ groove,
from which it is harder to find a way back to promoting normal activity and not
worry about sinister undiscovered problems.
“PCPs do this all the time, treating coughs as viral infections but checking
some for possible lung cancer… but then we are all used to coughs having trivial
causes rather than representing major disease, whereas we assume pain is a
message about damage and find it hard to override that,” she adds.
Dr Ann Taylor, reader in medical education at Cardiff University, agrees:
“Even if you have a magic bullet, you still need psychological and social
support to manage long-term pain effectively. Tiredness, anxiety, depression,
catastrophisation, social isolation, the inability to work and absenteeism are just
some of the issues that need addressing to help a patient successfully manage
this chronic condition in the best possible way.”
