Chronic Pain and the Family: A Problem-Centered Perspective.

Problems with drug dependency, a decrease in self-esteem, and conflicts with medical personnel are just a few of the difficulties that face the patient with chronic pain. The author, a social worker at the University of Manchester in England, explores another problem associated with patients who have chronic pain--the impact of pain on the family. The author describes the trials and problems involved in the marital and family relationships of 32 individuals who have chronic pain. He reports the results of a study that used a problem-centered approach to family therapy. This study included 12 patients with back pain and 20 patients with headaches, who had not responded to "conventional medical treatment" (a term not fully defined).

The assessment tool used for this study was the McMaster Model of Family Functioning. According to this approach, the family is an open system that consists of systems within systems (such as individuals, spouses, and children). The family is assessed for the following six areas: problem-solving, communication, roles, affective response, affective involvement, and behavior control. Each of these six dimensions is addressed in a separate chapter that includes case studies to help the reader understand this evaluation procedure. It is apparent from the information provided that all six of these areas are affected by chronic pain.

Throughout this book the differences between the responses of patients with chronic headaches and patients with chronic back pain--to questions such as duration of pain experienced--are very evident. The patients with headaches reported experiencing pain for longer periods than the patients with back pain. The patients with chronic headache were able to continue to manage at home and at work, whereas the patients with chronic back pain were often unable to continue performing in the family or at work. A problem common to all 32 patients was sexual difficulties, but again the problems were more serious for the patients with back pain.

Problem-centered systems family therapy is the treatment used by Roy for patients with chronic pain. This approach includes assessment, contracting, treatment, and closure. The advantages of this therapy are its practicality and the amount of control that the patient experiences.

Thirty-two patients were treated as part of this study. Sixteen out of 20 patients in the headache group and 4 out of 12 patients in the back pain group completed the treatment. The author emphasized the need for further study to determine why the patients with back pain did not comply as much with treatment as the patients with headaches. One possible explanation offered was that the patients with back pain were more committed to finding a medical cause and cure for their pain.

The main improvements noted by the patients who completed the treatment were in the intimacy of their relationships and in the enjoyment of social activities. Some patients with headaches reported a reduction in frequency and intensity of pain. In closing, the author suggested that perhaps a different strategy could be used to treat patients with severe chronic pain.

This book does provide some insight into the lives of patients with chronic pain. The case studies presented are interesting, and the concepts covered would be pertinent for any health professional. The fact that the patients' previous medical treatment is not described, however, makes this manuscript less useful to the physical therapy practitioner.