Page 105 Guide to Pain Management in Low-Resource Settings

Chapter 13

Psychological Evaluation of the Patient with Chronic Pain

Claudia Schulz-Gibbins

Why is psychological assessment Th e cause of increased pain perception can in-
of pain important? clude emotional components such as despair, sadness,
anger or fear, but it can also be a reaction to impair-
People who have painful conditions or injuries are often ment due to pain. In correlation with these processes,
additionally aff ected by emotional distress, depression, the cognitive component is the belief that it is not pos-
and anxiety. Chronic pain involves more than the sub- sible to have any relief of pain after unsuccessful treat-
jective experience of the intensity of pain. In the last 30 ments. Believing this can, for example, increase feelings
years a biopsychosocial model for understanding chron- of helplessness. Th e loss of belief in the functionality of
ic pain has evolved. According to this model, chronic one’s own body is experienced as a psychological threat.
pain is a syndrome with consequences such as physical Th oughts will increasingly focus on the apparently un-
and psychosocial impairment. Th is model contains vari- changeable pain problem. Very often the result is a re-
ables such as central processes on the biological dimen- striction of one’s whole perspective on life through
sion as well as on psychological dimensions, including the focus on pain. Th e consequence is that the person
somatic, cognitive, and aff ective dimensions. concerned very often retires from physical and social
Th e cognitive dimension contains, besides at- activities. Family confl icts arise because of the feeling
tention processes, attempts to come to terms with the of being misunderstood. Self-esteem is aff ected by the
pain experienced. For example, thoughts like “the pain subsequent inability to work. Th e main focus is on con-
is unbearable” or “the pain will never end” can have an sulting a doctor and obtaining a cure. Th e increasing
eff ect on the aff ective dimension and intensify reactions consumption of medication is accompanied by fear and
like anxiety. apprehension of side eff ects. Inactivity because of the
Suff ering from chronic pain has social conse- impairment by the pain and the whole symptomatol-
quences, for example, on activities of daily living, fam- ogy can cause and intensify depressive reactions such
ily environment, and cultural factors, or it may be af- as passivity, increasing cogitation, lack of sleep, and
fected by previous treatment experiences. Illness can be decreased self-esteem. In a vicious circle, chronic pain
viewed as the eff ect of the complex interaction of bio- can lead to depressive reactions, which infl uence the
logical, psychological, and social factors [2]. Emotional perception of and reactions to the pain. For example,
and cognitive aspects like anxiety or helplessness in biological processes such as muscle tension can cause
coping with chronic pain are correlates that can signifi - pain but can also be caused by increased depression.
cantly strengthen pain perception and intensity. Depression can lead to more physical passivity, and in
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 93
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.