Treatment of Pain and Pain Disability

Ideally, pain management recommendations follow logically from the biopsychosocial assessment and therefore address biological, psychological, and social influences on pain perception and disability. Because current pain experiences influence future pain experiences, clinicians benefit patients by making recommendations with a long-term perspective. Effective pain management can reduce anticipatory anxiety, improve future coping with pain, and reduce the likelihood of the development of pain-related traumatic stress symptoms. Therefore, approaches that will assist the child through the current pain as well as increase his or her efficacy to cope with future pain are ideal. For example, a child with cancer who learns how to effectively use visual imagery as part of a comprehensive plan to cope with lumbar punctures may successfully use this skill during future lumbar punctures as well as in other painful or distressing situations.

Many clinicians are unaware of the evidence base other than for commonly used medications. For example, some clinicians erroneously believe that a comorbid psychiatric disorder must be present for a cognitive-behavioral approach to be helpful or that medications should always be the first-line treatment. Consequently, both the consulting clinician and families may need to be educated about the evidence related to medications and other approaches. For example, meta-analyses reveal that hypnotherapy and cognitive-behavioral therapy can be more effective than medications in treating symptoms in adults with functional gastrointestinal disorders (Lackner et al. 2004; Whitehead 2006). Although less research has been done with pediatric samples, available evidence is consistent with this finding (Bursch 2008; Huertas-Ceballos et al. 2008).

Appropriate feedback is always the first intervention. Children (and their family members) should receive developmentally and situationally appropriate explanations of what to expect related to their medical condition, procedures, and treatments. Clinicians should include patients and their families in the decision making for pain control to ensure that the pain control options chosen are the most appropriate for the situation and to optimize adherence to treatment protocols. Basic comfort measures should be recommended for every patient (e.g., making alterations to the environment, considering optimal positioning, providing physical comforts, giving choice/control). Parents may require education about the evidence base and about the appropriate use of analgesia, as well as clarification regarding the risk of dependence and addiction.

Chronic pain can result in a sensitization of the nervous system, producing physiological and neuro-anatomical changes. Likewise, disuse or inactivity can lead to further pain and disability. Some patients with chronic pain develop severe impairment in their level of functioning. The term pain-associated disability syndrome has been used to describe a downward spiral of increasing disability and pain for which acute symptom-focused treatment is not sufficient to reverse the pain and disability trajectory (Bursch et al. 2003). For such patients, a rehabilitation model of treatment is important. In some ways, this model is parallel to the rehabilitation required after orthopedic surgery. For example, progress is initially measured by changes in functioning rather than by improvements in pain. For most, pain and/ or pain-related distress decreases once normal functioning is recovered. For children with pain-associated disability syndrome, normal functioning includes physical functioning as well as return to school and normal social and recreational activities. Adoption of a rehabilitation model frequently requires a large paradigm shift on the part of the patient and family, who may be fruitlessly searching for a single not-yet-discovered cause of the pain. Most have not previously heard of a fundamental disorder in pain signaling (causing pain in the absence of damaged or inflamed tissue) or think of medical problems as having multiple causes. Additionally, many believe that medications are the only legitimate treatment for pain and have not previously learned how to alter physiological functioning to impact pain and distress. Consequently, these patients and their families often require much education before treatment recommendations will make sense.

A Practial Guide To Self Hypnosis

A Practial Guide To Self Hypnosis

Hypnosis has been defined as a state of heightened suggestibility in which the subject is able to uncritically accept ideas for self-improvement and act on them appropriately. When a hypnotist hypnotizes his subject, it is known as hetero-hypnosis. When an individual puts himself into a state of hypnosis, it is known as self-hypnosis.

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