The social threats of COVID for pain pateints

The social threats of COVID-19 for people with chronic pain – free full-text /PMC7382418/ – July 2020

The negative impact of social changes prompted by the COVID-19 crisis may disproportionately affect individuals living with long-term painful conditions.

Living with chronic pain can threaten an individuals’

• fundamental social needs for autonomy (agency or independence),
• belonging (social connection), and
• justice (fairness).

In turn, for some, experiencing heightened social threat can maintain and exacerbate chronic pain.  

Effects of Social Distancing on Body and Brain

The Effects of Social Distancing on Body and Brain — BrainPost | Easy-to-read summaries of the latest neuroscience publications – Post by Anastasia Sares – June 2020

This virus is a true biopsychosocial disaster – very similar to the impact of chronic pain when we can no longer participate in active social lives or our favorite pursuits – but I don’t see anyone suggesting we are catastrophizing about it.

Humans evolved to be social with one another, and we function best when we have strong relationships and regular social contact.

However, in many cities, half or more of the inhabitants live alone, and in the current COVID-19 pandemic, people are additionally deprived of in-person interactions at work and social gatherings.

It is a good time to remind ourselves of the far-reaching impacts of loneliness and find ways to mitigate it. 

The Landscape of Chronic Pain

The Landscape of Chronic Pain: Broader Perspectives – free full-text /PMC6572619/ – by Mark I. Johnson – May 2019

Here is a recent lengthy review of what’s known about chronic pain: the various aspects of various types of pain under various circumstances.

This article shows the folly of making any numerical one-dimensional measurement of chronic pain, which can arise from a variety of causes, vary greatly over time and location, and make such intrusive incursions into our inner lives.

This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives.  

Individual Differences in Pain

Individual Differences in Pain: Understanding the Mosaic that Makes Pain Personal – free full-text article /PMC5350021/

This study, in the full text (link above), contains direct quotes from interviews of the patients. It was interesting to get such a  close-up look into other people’s pain.

The experience of pain is characterized by tremendous inter-individual variability.

Multiple biological and psychosocial variables contribute to these individual differences in pain, including demographic variables, genetic factors, and psychosocial processes.

Similarly, both genetic and psychosocial factors contribute to clinical and experimental pain responses. Importantly, these different biopsychosocial influences interact with each other in complex ways to sculpt the experience of pain.  

Acceptance of living with chronic pain – an ongoing process

”The acceptance” of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care – Journal of Rehabilitation Medicine – 2008

A growing body of evidence supports multimodal rehabilitation (MMR), compared with unimodal rehabilitation, for the treatment of patients with chronic pain.

MMR is based on a bio-psychosocial model that considers somatic, psychological, environmental and personal characteristics.

MMR includes a combination of physical and psychological interventions performed by an interdisciplinary team with a common goal, over a lengthy period of time. The patients collaborate actively with the team in goal-setting and reaching the goals.  

Questioning biopsychosocial treatments

Prickly issues: The biopsychosociality of pain might not necessarily mean biopsychosocial treatments work – Body in Mind – by Lorimer Mosely – October 10, 2018

A little while ago now, O’Keeffe et al published a systematic review and meta-analysis that showed little difference in effect between treatments they described as physical, psychological or combined.

The paper was vigorously criticised – arguing that the paper by O’Keeffe et al sets the pain field back by undermining the great advances in gaining traction for a biopsychosocial model of pain.

For some background, here are the broad definitions of the categories they used: 

Pain Catastrophizing: What Clinicians Need to Know

Pain Catastrophizing: What Clinicians Need to Know – Apr 2017 – By Robert J. Gatchel, PhD, ABPP and Randy Neblett, MA, LPC, BCB

during the past 2 decades, chronic pain clinical researchers began to emphasize the important role that certain specific sets of negative beliefs (such as catastrophizing and fear avoidance) play in the maintenance and exacerbation of chronic pain

Gatchel et al define pain catastrophizing as

“an exaggerated negative orientation toward actual or anticipated pain experiences…current conceptualizations most often describe it in terms of appraisal or as a set of maladaptive beliefs.”  

Bad thoughts can’t make you sick, that’s magical thinking

Bad thoughts can’t make you sick, that’s just magical thinking – Angela Kennedy | Aeon Ideas

The belief that physical illness can be psychosomatic, or caused by the mind, has long been seductive, capturing the imagination of doctors and writers alike.

Does this sound familiar? All the latest non-drug bio-psycho-social treatments of chronic pain are based on this flawed concept.

Contemporary, ad hoc resurrections of the concept of hysteria, now called conversion disorder, are commonly diagnosed by doctors and accepted by patients. 

Pain is largely a misunderstood construct

Pain – Thomas Dikel – Medium – Aug 2017

Pain is largely a misunderstood construct. This is odd, as everyone has experience with pain, and it has been studied extensively. Nevertheless, it remains a mystery, even to those who believe they know it best.

What we understand as pain is not a unilateral function. There are in fact two basic and primary components to pain.

The first is the obvious: the physical or “nociceptive” aspect, which involves specific and particular nerve cells that respond to specific and particular stimuli. 

Being Judged: The Swinging Pendulum and Pain Mgmt

Being Judged:The Swinging Pendulum and Pain Management – Kathleen Hoffman on Apr 10, 2017

Did you know that before the year 2000, poor pain management was called a major medical problem and was synonymous with poor medical care in the US?

On January 1, 2001, Congress declared 2001 to 2010 the Decade of Pain Control and Research.

Assuring that effective pain management occurred in hospitals, in 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCOH) added pain management criteria to the requirements they establish for hospital accreditation.