Mind and Body in Painby Shaheen E Lakhan, MD, PhD, MEd, MS | February 24, 2006
Engel‘s commitment to revolutionizing the health care sector remains important, for we are all affected as consumers, patients, practitioners, or administrators. His message is notably broad, for the scope of the holistic biopsychosocial model is virtually limitless – from psychiatry, immunology, and public health to pain, sexuality, and everyday life – and defines a wellness balance. This may explain the interconnected nature and difficulty in studying (and perhaps more so in treating disorders involving) these phenomena.
Dr. Hanson, director of the Long Beach VA Healthcare System Chronic Pain Management Program, strongly adopts the BPS model into his practice. In his patient handbook, he delineates essential BPS concepts and allows for much self-management for alleviating pain. He recognizes the neurological pathways that links stress hormones to pain perceptions. In a succinct discussion of the biochemical and physiological mechanisms of common pain relievers, Hanson describes the common pitfalls notably addiction and he leaves room for alternative approaches.
By implementing both physical and psychological pain coping techniques, Hanson furnishes a fine handbook with individual flexibility for the millions suffering from chronic pain. Promoting patient thought and by educating on the basics of pain perception and drug action, Hanson is practicing enlightening medicine – ultimately the patient is less frustrated, confused, and pained, while the mind has grown.
Hanson places great emphasis on the acceptance of pain:
While it is important to use problem-solving approaches whenever possible, we must also realize that there are many adverse situations and events in life that offer few if any opportunities for problem solving. Pain, suffering, disease, old age, and death are inevitable parts of human existence. No matter who we are, how healthy or physically fit we are, or how much money and power we have, we will all eventually die. Nothing can really prevent the physical aging process, erase unpleasant events that have already occurred, change who our parents and children are, alter our genetic make-up, or end reality of pain. For many, chronic pain and associated physical limitations are not so much problems to be solved (i.e., made to go away), but rather they are realities to be accepted. In fact, whenever you are faced with an unsolvable problem or an adverse situation that will never go away, you are forced to wrestle with the issue of acceptance.
He further differentiates the makeup of physical and psychological pain:
One of the most harmful and erroneous views held by many medical professionals and laypersons alike is the idea that pain must be either physical or psychological in origin. According to this commonly held and misleading idea, physical pain should be readily identified and successfully treated with medical diagnostic and treatment procedures. When the patient’s pain complaints are not successfully verified through medical diagnostic procedures and/or the patient fails to respond to medical/surgical treatment procedures, it is assumed by doctors that the patient’s pain is psychological. Another commonly used term for psychological pain is “psychosomatic.” The idea that the patient’s pain is psychological rather than physical is further reinforced if the patient shows signs of emotional distress, presents “exaggerated” pain complaints (from the viewpoint of the doctor), or admits having other life problems. Patients who hold this incorrect view usually assume that the doctor is incompetent if their condition is not adequately diagnosed or treated through medical means. According to this myth, pain that is physical in origin is real or legitimate, whereas psychological pain is seen as unreal, imaginary (“all in the head”), and illegitimate.
This distinction between physical and psychological pain is based on the philosophy of dualism which has pervaded Western medicine and culture. Dualism, which is commonly attributed to the French philosopher, Rene Descartes, separates mind and body. As emphasized throughout this Pain Handbook, we reject the philosophy of dualism. Mind and body are not separate. Pain is not just physical or psychological, it is both. Pain is ultimately processed and experienced by the mind-brain system which includes both physical (sensory), mental, and emotional components.
Mental Context – A Delicate Subject
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