Page 110 Guide to Pain Management in Low-Resource Settings

98 Claudia Schulz-Gibbins

More often than not, confl icts of goals may problems, and most had better results. He is now consid-
arise; existing and resulting psychosocial problems can ering suing the surgeon.
come into confl ict with the aim of possible recovery. Of- During his stay, further discussion was arranged
ten the patient is not aware of, or else has no abilities between him and the surgeon. Th e surgeon apologized
to cope with, the existing physical failures of daily func- that the operation in this case did not bring about the
tioning. Th e problems cannot be compensated for on desired result. Although the operation was quite similar,
one’s own. Th e patient is under extreme psychological Mr. Andrew had a much more progressive disease, and
and physical stress. If confl icts of goals exist, it is help- the operation itself was technically diffi cult. Th is was ex-
ful to discuss these confl icts and any possible negative plained with the help of pictures and models. Afterwards
consequences with the patient during the course of the Mr. Andrew said he would refrain from suing, since he
treatment and explore possible solutions. was better informed now. Th e pain does still exist, but
Mr. Andrew knows now that he has to live with the im-
Do fi nancial compensation/legal issues pairment and has a more positive outlook.
interfere with recovery from chronic pain?

Possible risk factors making treatment and subsequent What would be a typical case of intense stress
recovery more diffi cult are accidents at work, accidents within the family?
caused by third parties, or unsuccessful medical treat- In a biopsychosocial framework, the immediate so-
ment. Results can be post-traumatic stress disorders cial environment, such as the patient’s family, has to be
or adjustment disorders with a long-lasting depressive taken into account. In this framework, diverse prob-
reaction. Legal problems, such as lengthy proceedings, lems exist that have an additional eff ect on the pain syn-
compensation for injury at the workplace, or injury drome. In the literature, there are three main theoretical
caused by a third party can prolong the healing process. approaches evaluating the importance of family in the
Th e desire for compensation, in the sense of approval of co-creation and maintenance of chronic pain. Within
the damage suff ered, can have psychic as well as fi nan- the psychoanalytical approach, there is an emphasis on
cial aspects. Often, a fi nancial settlement is considered the intrapsychic processes and confl icts as well as early
as a partial compensation for the pain and lost work. If childhood experiences that may infl uence and perpetu-
a settlement is not made, there is further psychological ate the experience of pain. Here, it is assumed that sup-
upset, resulting in anger, despair, and increased pain. pressed aggressions and feelings of guilt, as well as early
Th e patient feels that the pain he or she personally suf- experiences of violence, both sexual and physical, along
fered is not acknowledged. with deprivation, can lead to psychosomatic confl ict.

Case report 2 Case report 3

A 62-year-old salesman, Mr. Andrew, reports increased A 32-year-old bank accountant, Mrs. Agbori, describes
back pain after a back surgery. In the same room, he abdominal pain of several years’ duration. She had been
says, there has been another patient who had the same diagnosed as having endometriosis and has had several
operation. His roommate was mobilizing 2 days after surgeries, which were unsuccessful in relieving her pain.
the operation and was almost pain free at the time of Th e only measure that had any eff ect on her pain, each
discharge. Mr Andrew believes that during his own op- time for several months, was treatment with a “hor-
eration, an error must have occurred. He considered mone preparation,” which, however, has made her “ster-
that this was no surprise, given the number of proce- ile.” Th is upsets her very much because she and her hus-
dures that were done daily and the stress on the doctors. band wanted children. Apart from the pain she has no
He has tried to speak with his surgeon several times, other physical problems, she says. Th e relationship with
only to be told that the pain would settle down soon. Th e her husband is stable, and Mrs. Agbori is very content
surgeon, he thought, seemed quite abrupt with him, and at work. Her entire family is very loving and caring, and
did not really take time to explain things. He cannot support her.
understand the explanation of the surgeon because his During further interviews, Mrs. Agbori reports
former roommate at the hospital felt fi ne immediately of having constant back pain for several years. As a
afterwards. He has talked to a lot of people with similar 10-year-old she had to wear a body cast for almost half