PSYCHIATRIC ASPECTS OF CHRONIC PAIN.Treating chronic pain is basic to the very heart of medicine, as we seek to ease suffering and improve function. However, it is surrounded by controversy and opinions held with nearly religious fervor. We want to help, but we do not want to contribute to drug abuse or be used by people lying to get drugs they really do not need. The psychiatric aspects of chronic pain are complex and broad, ranging from the biochemical interaction between pain, sleep, mood and medical problems; to the long term effects of trauma and anger on muscle tension and spasm; to spiritual questions involving the meaning of pain and the purpose of our lives. Since leaving any one of these and many other problems unaddressed can result in a poor response to treatment, we would all do well to at least be able to identify potential problems, treat those that we can, and guide our patients in a positive direction for those which we cannot treat. Biological issues involve the treatment of primary illnesses such as major depression and panic disorder Panic Disorder Definition A panic attack is a sudden, intense experience of fear coupled with an overwhelming feeling of danger, accompanied by physical symptoms of anxiety, such as a pounding heart, sweating, and rapid breathing. . The ability to ask about and recognize symptoms of psychosis psychosis (sīkō`sĭs), in psychiatry, a broad category of mental disorder encompassing the most serious emotional disturbances, often rendering the individual incapable of staying in contact with reality. , bipolar disorder bipolar disorder, formerly manic-depressive disorder or manic-depression, severe mental disorder involving manic episodes that are usually accompanied by episodes of depression. , and potential for harm to self or others is important. Basic knowledge of the use of a few well-chosen medicines will provide a good beginning for the treatment of most patients. One must be aware of the complex possibilities for drug interactions and be able to rule out medical problems such as thyroid, [B.sub.12], and hormonal abnormalities. Drug problems, including alcohol and caffeine caffeine (kăfēn`), odorless, slightly bitter alkaloid found in coffee, tea, kola nuts (see cola), ilex plants (the source of the Latin American drink maté), and, in small amounts, in cocoa (see cacao). must be addressed. Sleep abnormalities such as sleep apnea sleep apnea, episodes of interrupted breathing during sleep. Obstructive sleep apnea is a common disorder in which relaxation of muscles in the throat repeatedly close off the airway during sleep; the person wakes just enough to take a gasping breath. and restless leg syndrome restless leg syndrome Nocturnal myoclonus Sleep disorders A clinical complex characterized by nocturnal cramping of the anterior calf, restlessness, a feeling of heaviness, aching, painful paresthesia and tingling in legs with uncontrolled twitching, relieved by can complicate treatment. Many patients with intense pain that is poorly responsive to treatment, especially with problems with muscle spasm muscle spasm n. Persistent increased tension and shortness in a muscle or group of muscles that cannot be released voluntarily. muscle spasm, n and chronic headaches have unresolved anger and grief that will interfere with treatment. Often counseling cannot help, either because of cost, availability or patient bias, but many people benefit a great deal from a few simple tools they can use at home. Finally, many patients struggle with spiritual issues, ranging from anger toward God for their condition, to a sense that their pain is a punishment that they cannot escape. These struggles can complicate treatment with increased depression, spasm and problems with compliance when patients abruptly discontinue treatment. Simple answers generally are not helpful but it is amazing a·maze v. a·mazed, a·maz·ing, a·maz·es v.tr. 1. To affect with great wonder; astonish. See Synonyms at surprise. 2. Obsolete To bewilder; perplex. v.intr. how much relief comes from permission to ask the difficult questions. Patients can turn to books, counselors and clergy consistent with their own faith as they look for answers. Wayne T. Gossman, MD Ivy Center, Suite 100 2057 Valleydale Rd. Birmingham, AL 35244 |
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