Our scientific understanding of acute pain vastly overwhelms our knowledge about chronic pain. While there are many isolated pieces of information, there is no cohesive explanatory theory of chronic pain. While acute pain is dependent upon the degree of tissue injury and inflammation, the progress of uninterrupted healing, our psychological response to and prior experience with chronic pain is often reported in the absence of continuing or increasing tissue damage or overt inflammation, and in the midst of apparent healing (as adequately as our bodies are capable), tens of millions of Americans suffer from chronic pain.
Perhaps it is the “suffering” that is the more important aspect of chronic pain. Here science gives us a wild assortment of explanations, which conveys to me only one thing; no one knows why pain sufferers suffer. So, if suffering is the central feature of chronic pain, yet we cannot explain it in a meaningful or useful way, treatment should arguably focus on lessening suffering, and for now, ignore the fact that suffering cannot be adequately explained or understood.
A very interesting phenomenon has been noted by many of our patients. They tolerate their pain and reduce their overt suffering, if they embrace their pain, as though it were a natural part of their bodies' experience, which of course it is. Patients who suffer the most are divided into two categories: those who cannot accept the fact that they were initially injured, angry at the causal event or the circumstances in which they find themselves, and those who are hyperaware of the presence of pain, to the extent that they cannot lead even close to a premorbid existence, furthering the extent of pain through deconditioning and weight gain. Therapy should be directed toward achieving a balance between these two quite different responses to chronic pain.
Those patients who seem to suffer less or not at all with reported severe pain are those who accept the pain as part of their being, yet are determined to achieve the highest level of function. This balance is a thesis of the "mindfulness" philosophy in which meditation is the tool to accept and achieve without anger and stress that typically accompanies chronic pain. Mindfulness may well become a very important tool for pain practitioners and their patients.
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