By Terry Altilio, MSW, ACSW
|Physical and Emotional Factors|
|Culture and Pain|
|How Social Workers Can Help|
Pain is unique in that everyone has pain at some time or another and in fact it is essential to survival. Pain signals that the body is or has been injured and thereby warns us to take action. People who do not feel pain do not receive this signal and cannot protect themselves from further physical harm. Most of the time pain dissipates as healing takes place and we continue on the path of our lives.
As people grow from child to adult, they experience pain and are taught through their families, their cultures, and their spiritual beliefs how to think and act when in pain, what to expect from others, and the meaning of pain in their lives. While pain is a very personal and subjective experience, sometimes the impact expands beyond the individual to family, to work life and other areas of pleasure and fulfillment.
Over the years, research and clinical experience has led pain experts to believe that pain is not just physical but rather involves interrelated variables such as our unique history, the meaning of pain, motivational factors and emotions.
For example, the pain that results from a marathon run is filtered through feelings of accomplishment and pride and has a meaning that is infused with the months of training that preceded the race.
This experience is essentially different from pain caused by recurrent migraine headaches that are unpredictable, disruptive of work and family life, and bring to mind a flood of sadness and anger left over from an adolescence interrupted by the same pain problem.
The two kinds of pain that people experience are acute and chronic pain. Acute pain is of recent onset and short duration and the response is often one of anxiety and an emergency fight or flight reaction. We have all experienced acute pain and usually expect that it will go away when the injury heals. Depending on the nature of the pain and our health behaviors, we may or may not seek medical attention.
Chronic pain is defined largely by time and outlasts the healing of an acute injury, recurs frequently over a period of months, or is associated with a lesion that is not expected to heal. Chronic pain becomes like any other chronic illness and as opposed to acute pain, the focus often changes from searching for the cause and cure to managing the pain itself.
Over time, people may respond to chronic pain with depressive symptoms such as sleep and appetite disturbance, irritability, or loss of interest in activities and relationships. This reaction sometimes leads others to wrongly conclude that the person has no pain which can increase emotional distress and the feeling of aloneness that many people with pain experience. Sometimes, in an effort to convince the world of the severity of pain, people adapt extreme behaviors to express their pain.
In our culture, pain has been at the center of regulatory, media, and legislative attention. Many pain problems are helped by a class of medicines known as opioids. These medications have the potential to be abused by people who have the disease of addiction and there has been much media attention about the abuse of prescription medications. At the same time, the fact that some people abuse medications should not mean that people who can be helped by them should go without. There is much evidence that people suffer from undertreated pain and that is not acceptable in a caring and just society. The challenge is to ensure that people in pain have the option for proper medication and that those who have the disease of addiction are offered the treatment that they need.
Just as the experience of pain is unique so is the response of individuals and their families to a chronic pain condition. Sometimes major life changes result and people need to learn new skills to cope and adapt. Other times people struggle with decisions about healthcare, treatments, and financial issues. They may need help to re-enter the world such as choosing to return to school or work.
Social workers with a knowledge or interest in pain can assist you and your families to
- Understand how your values, beliefs, hopes, emotions, and history impact pain and functioning
- Explore ways to mediate the impact and meaning of pain in your lives and the lives of others
- Explore the reciprocal relationship between biological, psychological, cultural, spiritual, social, economic, family, and political aspects of your experience of living with pain so you can create the best quality of life
- Work with you to identify your strengths, areas of competence and control
- Teach skills and strategies to enhance your life such as relaxation, breathing exercise and goal setting
- Assist you in problem solving and decision making as we know that considering options such as applying for disability or taking chronic medications have symbolic meaning and requires attention to the losses and adaptations that you and your family may make
- Advocate and negotiate systems
- Locate resources such as the American Pain Foundation http://www.painfoundation.org/ and www.stoppain.org for education, advocacy, and networking.