Page 353 Guide to Pain Management in Low-Resource Settings

Chapter 46

Psychological Principles in Pain Management

Claudia Schulz-Gibbins

What can we use for acute pain? for cancer pain as well as for pain caused by HIV, there
is the same relationship, in the framework of the biopsy-
Acute pain occurs mainly in connection with an illness chosocial concept, as with other chronic pain models.
or injury or as an eff ect of a treatment of an illness (e.g., Th e prevalence of comorbidities such as anxiety and
postsurgical pain). In contrast to chronic pain, acute depression is common, as in other pain syndromes, and
pain is an alarm signal to the body. Normally, the cause should be taken into consideration and treated. Often
is noticeable, and the treatment is mostly rest and man- these disorders are ignored. Additionally, patients have
agement of the cause of pain. Th e psychological eff ect is to cope with pain due to a tumor, as well as pain that
the hope that the treatment will be successful and the may arise during the course of the treatment. Overcom-
pain will be over soon. It is possible that anxiety and ap- ing the consequences of chronic diseases diff ers signifi -
prehension may appear within the period of acute pain, cantly in developed countries in contrast to developing
for example, the fear of surgery and anesthesia that countries. Caring for the ill person is often very diffi cult
could form part of the treatment. for the family because of fi nancial problems. A diffi cult
fi nancial situation and poor access to medical, nursing,
Practical consequences
or other social services can aff ect the process of healing
As part of preparation for surgery, interventions such as negatively. At the time of diagnosis, there is often a loss
relaxation techniques, a good explanation of the proce- of control and helplessness in the face of possible physi-
dure and possible outcomes, and an optimistic outlook cal disfi gurement, accompanying pain, and possible fi -
have been proven to be helpful. It is possible to reduce nancial implications for adequate treatment, not least
postoperative pain experience through such knowledge. the fear and uncertainty surrounding the prospect of an
Knowledge about the treatment can often reduce one’s untimely death. Additionally, questions of guilt can lead
anxiety. Relaxation techniques can minimize psycho- to psychological strain because of trying to own up to
logical agitation patterns such as a high heart rate and one’s own responsibility for a disease, for example: “It’s
inner restlessness. my own fault that I have a tumor, because I have been
smoking too much,” or “Being infected by HIV is be-
What can we use for cancer cause of my irresponsible sex life.”

and HIV/AIDS pain?
Practical consequences
In the treatment of chronic pain, it is important to dif- Adequate counseling and emotional support should
ferentiate between benign and malignant pain. However, be integrated in the provision of health care for these
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 341
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.