Psychological Factors in Women’s Chronic Pain Care Research Paper

Abstract

The increased prevalence of chronic pain in women is alarming. More studies link the condition to clinical, developmental, gender, and family conditions related to differences in perceiving pain. Chronic pain results from biological, social, and psychological elements. The treatment is a complex health phenomenon involving a combination of biopsychosocial and multidisciplinary interventions. Psychological treatment of chronic pain is an emerging field of study. This literature review seeks to key out the psychology of chronic pain assessment and treatment in women by reviewing current statistics, symptoms, causes, and biopsychosocial interventions.

Introduction

Chronic pain can be defined as an emotive experience that changes the emotions and physical impressions of people. From a biopsychosocial viewpoint, the condition is viewed as an illness characterized by the multifaceted experience that influences peoples’ emotions. Therefore, it has an informal relationship with depression (Roditi & Robinson, 2011). This relationship, as explicated by the Harvard medical school, is interchangeable as patients with chronic pain risk developing psychiatric symptoms and depression (Harvard Mental Health Letter 2004).

Unrelieved pain is a shocking public health challenge designed by discrepancies of prevalence, inconsistency, significance, vulnerability, and the importance of prevention. Regardless of advancements in research and expertise, the problem affects a large number of the American population. Its continued growth has introduced the nation to significant healthcare demands arising from increased disability, mortality, and morbidity rates. Chronic pain affects nearly every component of a person’s life, and individuals are limited by the aches they experience. It also contributes to depressive symptoms, restlessness, fatigue, and touches on women’s life significantly. This paper will discuss the psychology of chronic pain assessment and treatment in women.

Statement of the Problem

The last few decades have been qualified by a sudden growth of knowledge on the subject of the anatomical and physiological mechanisms that lead to the psychosocial factors of pain. As a consequence, numerous pharmacological, psychological, and surgical treatment procedures have been invented (Turk & Okifuji, 2002). This evolution and revolution have shown the meaning of psychological interventions in coping with continuing pain.

Besides, the contributions of such interventions have received practical support from a number of health care institutions (Kerns, Sellinger & Goodin 2011). The realization that pain is influenced by a broad range of psychosocial factors such as emotions, beliefs, attitudes, and biological agents has brought is changes in the treatment procedures used. Chronic pain remains for long periods of time and thus influences all facets of a person’s emotional, physical, and societal performance. Thus, treatment interventions should focus on moderating pain and any other accompanying symptoms.

Of late, the prevalence of chronic pain in women compared with men has significantly increased (Croft, Blyth, & van der Windt, 2010). Evidence from recent studies reveals that females are more susceptible to clinical pain conditions, especially postoperative and procedural pain (Fillingim et al., 2009). A number of health-related conditions are associated with gender and sex differences in pain perception. Epidemiologic studies also reveal that women have more pain and depression from certain diseases such as cancer (Green et al., 2011).

A number of inconsistencies in treatment intended for minorities and the elderly patients exist, and thus, there is increased treatment dissatisfaction among patients (Gupta, Weber & Duwell, 2013). Even though women report pain that is frequent and severe, the treatment offered is less aggressive (Ballweg, Drury, Cowley, McCleary, & Veasley, 2010). More frequently than not, health practitioners take women pain less seriously and presumably describe the reports as founded on emotional and psychogenic unrealities resulting in psychotic diagnoses rather than pain treatment.

Inadequate data and knowledge about conditions leading to chronic pain in women remain unknown to more than half of the population affected. Without a doubt, the same tendency exists among care professionals who are unable to diagnose and treat common conditions. As a result, most of the conditions leading to chronic pain in the female population are poorly understood. The causes and overlapping patterns also remain unknown. Interestingly, in the quest to seek possible answers, a number of theories link the problem to genetic, inflammatory, hormonal, environmental, and immunology factors. These inquiries can simply be answered through well-coordinated psychological and pharmacological scientific-based efforts.

Chronic Pain Assessment and Treatment in Women

Current statistics

A survey led by the Institute of Medicine Committee on Advancing Pain (2011) discloses that most chronic pain syndromes occur only in adult females. For example, Chronic Fatigue symptoms occur four times more in women than in men, fibromyalgia occurs nine times more in women than in men, endometriosis rarely occurs in men whilst vulvodynia only occurs in adult females. Appendix I reveal the disproportional prevalence rates of chronic pain disorders in America.

Approximately 50 million American women suffer from one of the mentioned chronic disorders (Ballweg et al., 2010). Current research reveals degrees of co-existence and overlapping among the conditions. Even though overlapping rates remain non-established, it is significant to identify two or three conditions in some women. In most instances, one condition progressively leads to the other. However, individuals may concurrently experience symptoms of several conditions.

For instance, 20 percent of adult females suffering from endometriosis have other irritating conditions, such as internal cystitis and vulvodynia (Ballweg et al., 2010). From the statistics, it is clear that chronic pain disorders subject women to severe pain than humans. Likewise, women hurt more from common types of pain, such as head and backaches.

Symptoms

The symptoms of chronic pain vary depending on individual characteristics. As a result, making a precise diagnosis is often difficult. Generally, pain is considered chronic if it runs for more than six months. Continuing pain in adult females is linked with a number of health conditions that exhibit physical, emotional, and psychological symptoms, as shown in appendix II and III. The condition is likewise linked with a bit of psychological symptoms that involve the cognitive and emotional facets of an individual.

As indicated in Appendix III, patients are prone to suffer from depression, stress, and related psychological disorders. These emotional states cannot be overlooked as they exacerbate the status. Symptoms of fatigue, anxiety, depression, irritability, and stress have complex associations that should be addressed during treatment to avoid dire complications.

Psychological therapy significantly eliminates possible threats (Katzman et al., 2014). In epidemiological studies, it is evident that syndromes associated with anxiety, depression, and disability support the need for psychodynamic mechanisms of pain management. Symptoms related to these disorders have a negative prognosis when they co-occur. Even though studies may generate inconsistent results, it is critical to clarify relationships among present disorders.

Causes

The rise in the prevalence of chronic pain mainly originates from the combination of developmental and family issues. Surveys have documented disparities depending on age, gender, and genetic factors (Fillingim et al., 2009; Thomas, 2010). The popularity of chronic pain among the elderly is gradually increasing. Even though most research conducted has not yielded uniform results, a number of scholars have linked advanced age to declining pain sensitivity and mild noxious stimuli (Gibson, 2006). In increase, associated symptoms in older people can be caused by musculoskeletal disorders, post-surgical pain, and chronic diseases.

As discussed earlier, women are prone to more pain than their male counterparts. This condition is associated with a number of developmental disorders that mostly occur in females. Differences in hormonal functions, body size, psychological traits, cognitive variation, and social expectations contribute to varying gender prevalence (Fillingim et al., 2009). A number of hypotheses also believe the society expects females to report more pain than men.

Genetic research has shown the nexus between genetics and the ability to transmit pain-related stimulation. The functioning of the cardinal neural system is prone to genetic factors that may either increase or decrease the transmission of nociception signals to the brain. This process is controlled by the body’s ability to release hormones that can be affected by genes. Heredity factors may also affect the natural selection of neurons, creating variations in pain tolerance and analgesic response. Inherited disorders such as endometriosis, vulvodynia, dementia, and Alzheimer’s disease may introduce chronic cause pain. Ultimately, racial and cultural disparities are as well recognized to create cultural perspectives that strongly determine the perceptual experience of pain.

Treatment

The rising popularity and multi-dimensional nature of pain require ideal comprehensive and combined management. Existing approaches have gone past formal interventions such as physical, surgical, and pharmacological approaches. These methods have solely recognized organ pain management. Patients mostly understand the biopsychosocial causes of their pain and follow treatments intended for the assumed cause.

Even so, some do not get to the bottom of their pain despite numerous pharmacological and therapeutic interventions. As a result, persistent pain develops from acute to chronic pain, whose consequences manifest in all aspects of life. It becomes a biopsychosocial predicament and contributes negatively to the physical, emotional, and psychological health of an individual. At this point, diversification of treatment to include both pharmacological and psychological approaches may be considered.

Psychological approaches for chronic pain management developed as a consequence of the “neuromatrix” and the “gate- control” philosophies of pain, which contemplate the ability of the psychosocial and physiological process to affect the perception of pain and recognize their influence as treatment elements involved in the states of pain (Roditi & Robinson, 2011). As a consequence, modifications in the unimodal therapies that were ruled by biological perspectives were respected, and clinicians embraced the intricacy of pain treatment. Recent interventions identify a treatment framework from different studies that target both the organ and cognitive pain.

The interdisciplinary frameworks include the combination of pharmacological therapies with physical, behavioral and psychological therapies. These approaches address pain management more adequately at all tiers of an individual, including behavioral, molecular, functional and cognitive functioning. Biopsychotherapeutic approaches lead to positive and long lasting results, and are more affordable (Roditi & Robinson, 2011; Kerns, Sellinger & Goodin 2011).

Psychological treatment is a substantial element of the multidimensional framework. Treatments are basically based on biopsychosocial and psychological research methodologies with the purpose of identifying the role of emotional, behavioral and cognitive patterns related to maintenance of pain (Kerns, Sellinger & Goodin 2011). The biopsychosocial model is the most common accepted approach to understanding pain (Gatchel 2005).

The use of psychologically-based interventions depends on the nature of the multidisciplinary pain treatment program, which is guided by patient characteristics and nature of pain. Therefore, overlooked behavioral, emotional and cognitive elements of chronic pain are targeted. Based on insights from Hoffman et al. (2007), the common psychologically-based treatments are frequently employed include:

Cognitive behavioral therapy (CBT)

Research has discovered that CBT is an effective intervention in treating chronic pain (Roditi & Robinson, 2011; Eccleston et al. 2012). Empirical studies by Hoffman et al. (2007) document the success of cognitive therapy in managing chronic low back pain by significantly eliminating the physical and psychosocial independence. Similarly, a therapeutic randomized systematic review for adult pain management revealed that CBT altered mood outcomes (Eccleston et al. 2012).

This intervention applies psychological doctrines to modify behavior and cognitive changes in a patient. Its application is primarily characterized by psychoeducation about pain and behavioral components related to the syndrome (Roditi & Robinson, 2011). In addition, the model introduces problem solving approaches through training patients about coping strategies depending on the intensity and the cause of their pain. Behavior modification components basically incorporate behavioral stimulating strategies and numerous recreational activities. Coping skills are employed to identify existing maladaptive coping strategies. Problem-solving techniques are used throughout the treatment to encourage patients to maintain positive efforts and improve their value of life.

CBT applies cognitive restructuring interventions that increase patient awareness about current maladaptive thoughts, do away with negativity, and generate adaptive thoughts (Roditi & Robinson, 2011). The exercises enable patients to be cognizant of their emotions, and they can regulate their pain either positively or negatively. This instills patients with increased positive awareness of their pain resulting in better management of behaviors and thoughts related to pain. Most importantly, patients are made mindful of the significance of their agony.

Treatment is rendered in a patient-supportive environment that fits the patient’s biopsychosocial pain. The therapy is delivered in the form of the teacher – student model, where therapists are viewed as the teachers and patients learners. The learners are equipped with relevant knowledge and skills to manage, and not completely eradicate the pain. The main goal of therapists is to increase understanding of pain and put in management efforts to enhance life. Therefore, self-monitoring of behaviors, emotions and thoughts are significant components during therapy.

Cognitive therapy offers a chance through which therapists’ foster therapeutic environment that encourages patients’ skills in finding out from their skills and improving their failures. The most interesting feature in this approach is the ability of the patient to actively participate in their pain rehabilitation program as they work together with the therapists to identify treatment barriers and adopt practical programs.

Biofeedback

Psychologists use psychophysiological therapies for pain associated with temporomandibular disorders and headaches (Yucha & Montgomery, 2008). These interventions use of lifestyle changes with the intention of improving bodily processes and developing improved coping skills for stress. The primary technique used is biofeedback, which offers a patient the ability to interpret bodily processes (Roditi & Robinson, 2011). A survey conducted by Nestoriuc & Martin (2007) revealed biofeedback interventions reduced migraine attacks and prolonged self-efficacy. Physiological responses are transmitted by a variety of measurement equipments that can record information about various physiological processes such as blood pressure, electrical activity, heartbeat rate, skin temperature and brain performance.

Psychophysiological interventions have a principal goal of equipping the patient with insights about how to initiate the physiological self-regulatory process through voluntarily control of numerous bodily processes (Turk & Okifuji, 2002). As a result, patients improve their physiological flexibility as acquired skills enable them to regulate undesired activities, including physiological reactions.

Behavioral approaches to treatment

Behavioral reinforcement is an important element in maintenance of pain behaviors. Pain is subjective and can only be felt by the sick person. Behavioral observations and cognitive inquiries enable therapists to know about the intensity of an individual’s pain. Behavior is used as an agent of communication observed from elicited response. Negative reinforcement arises when patients evade undesirable behaviors that reduce distress.

As a result, a behavior is strengthened since negative condition is eliminated. Counteractive feedback is a necessary tool that distinguishes between harm and pain. It is utilized by doctors to influence patients’ behaviors by demonstrating the potent reciprocal relationship. Inquiry reveals that therapists prescribe pain management medication based on behavioral observations (Turk et al. 2008). Therapists have developed two approaches to reinforcing and conditioning behaviors.

Respondent Conditioning

When noniceptive and neutral stimulus are paired, it is probable that a pain response will be elicited resulting to respondent conditioning. Patients with chronic pain encounter pleasurable activities that may provoke pain. Earlier or later, these patients may anticipate fear or pain and restrain from the natural process leading to impairment. The defense mechanism may also extract physiological processes that worsen pain. Thus, the model is applied to increase pain stimulation through repeated engagement in behaviors that produce less pain, and thus reducing defensive fear.

Operant Conditioning

The model focuses on elimination pain behaviors by introducing positive ones. The paradigm is not aimed at uncovering the cause of symptoms, but rather, managing pain behaviors by adopting positive ones. To achieve positive results, therapists’ draw more attention to reducing and ultimately eliminating the connection between behaviors and their consequences. Thus, there is increased maintenance of desired behaviors and elimination of pain-compatible behaviors.

Acceptance-based therapy

Recent studies about the effectiveness of acceptance-based approaches for management of chronic pain have reported significant elimination of pain-related anxiety and disability (Roditi & Robinson, 2011). The most common therapies include hypnosis, guided imagery and motivational interviewing. These models lay emphasis on the importance of a patient’s progress through increased psychological elements. When dealing with chronic pain, the paradigm conforms to established psychological flexibility through acceptance, commitment, individual presence and cognitive recovery.

Through acceptance, patients are able to positively embrace pain rather than trying to convert it. Modification and restructuring techniques are used to alter undesired activities and recover thoughts. The presence of a patient in the therapy develops volunteered non judgmental interaction between the self and private thoughts. The process introduces an individual to the values that guide their own behaviors. Thus, the model introduces patients to a holistic approach of managing pain through acceptance and learning how to live with it.

A Biblical Response to Chronic Pain

Biblically, the ultimate goal in dealing with chronic pain is not to remove, transform, or redeem it, but rather to pray for relief. Most of the interventions discussed in later parts may not be helpful. The scripture talks about the welfare of suffering. Patients should understand their suffering through Christ, whose mercy and grace helps them discover the meaning of their liveliness. Each individual’s life is embedded to Christ, meaning that pain comes about within the context of God working of His role in history.

Pain is directly connected with Christ, who suffered on the cross for the sake of the sins of the world. Besides, the suffering after the cross has Christoriented perspectives that involve human beings to participate in Christ’s suffering. Recitations from the New Testament encourage Christians not to get surprised by the afflictive trials, but instead to rejoice through participating in Christ’s suffering (English Standard Version, 1 Pet. 4:12-13).

Likewise, in the book of Corinthians, a parallel relationship has been established between people’s sufferings and Christ’s comfort (2 Cor. 1:5). Emlet (2005) believes “suffering was meant to occur in a community of Christ-followers” (p. 25). Therefore, patients should accept the power of the resurrection of Christ through participating in the fellowship of his suffering by accepting pain as part of their life.

Tips for Coping with Chronic Pain

The seriousness of the effects on chronic pain in women has negative impacts on their ability to work effectively leading to poor quality of life. Nevertheless, a number of steps can be helpful in altering behavior patterns related to serious pain.

1. Physical exercise: Physical exercise promotes the body’s shape. Defense mechanisms related to pain affects the rate of people to remain active. This leads to negative results such as disability and overdependence. Therefore, patients should strive to remain active and engage in everyday human actions.
2. Setting desired goals: Pain management requires realistic goals developed from personal motivation. For this reason, people should recognize their physical limitations and set manageable goals.
3. Distracting Pain: Instead of musing about the intensity of pain, distraction of the mind through social and physical activities encourages pleasant experiences which aid in management.
4. Maintaining strong social connections: Social support is an important factor that brings up hopes of chronic pain patients. Social support also gets rid of depressive and anxiety symptoms through talking and sharing opinions.

Summary of Findings and Recommendations

Despite numerous medical and psychological efforts, the number of untreated cases is increasing enormously. These events are primarily caused by neglect, dismissal and discrimination faced by women during treatment. The pathophysiological interventions used to handle pain marginalize the importance of pain management in improving the quality of aliveness. Worst of all, despite the fact that most patients affected by the condition contribute to the health care bill, they still continue suffering because:

1. Treatment interventions are poorly understood
2. Gender discrimination during treatment subjects women to prejudiced treatment and diagnosis.
3. Physicians and health care providers lack adequate skills and training on pain management conditions that strike women
4. Clinicians lack empirical data on which to base treatment recommendations.

As a consequence, attempts should be attained to:

1. Produce cost effective research investments that provide research-based evidence about intervention effects
2. Train health care professionals about appropriate diagnoses that treat chronic pain disorders in adult females.
3. Increase public awareness about the nature, causes and management of chronic pain.

Conclusion

In conclusion, chronic pain in women is influenced by the combination of biological, psychological and societal factors. So far, most of the treatment interventions described do not eliminate pain successfully. Therefore, people have to accommodate and learn self-management skills. Various psychological interventions support the treatment process. To date, only cognitive behavior therapy has recorded high rates of success. Thus, the combination of psychological treatment with scientific interventions seems to be the prudent way towards achieving desired outcomes.

Appendix I

Prevalence Rates of Chronic Pain Disorders in America

Appendix II

Main Causes of Chronic Pain in Women

1. Endometriosis: A gynecological condition characterized by appearance of cells on the lines of the uterus causing pain and infertility. When severe, patients experience painful menstrual periods.
2. Chronic Fatigue Syndrome: A syndrome characterized by exhaustion and low energy.
3. Fibromyalgia: A chronic condition characterized by widespread pain in the muscles and allodynia.
4. Interstitial cystitis: An inflammatory condition described by increased pressure in the bladder.
5. Vulvodynia: A chronic syndrome characterized by burning pain and discomfort in the vulvar.

Appendix III

Symptoms of Chronic Pain in Women

Common Symptoms

1. Severe pain that persists after duration of time.
2. Shooting, electrical, burning, or aching pain.
3. Feelings characterized by discomfort, stiffness and tightness.

Psychological Symptoms

1. Stress.
2. Sleeplessness.
3. Fatigue.
4. Anxiety Disorders (Bipolar, ADHD, Autism).
5. Withdrawal from social life.
6. Mood instability such as feelings of hopelessness, anxiety, irritability, depression and stress.
7. Disability and increased dependency.

References

Ballweg, M., Drury, C., Cowley, T., McCleary, K., & Veasley, C. (2010). Campaign to end chronic pain in women. Chronic pain in women: Neglect, dismissal and discrimination. Web.

Croft, P., Blyth, M., & Van der Windt, D. (2010). The global occurrence of chronic pain: An introduction. In: P. Croft, M. Blyth & D. Van der Windt (Eds). Chronic pain epidemiology: From aetiology to public health (pp. 9–18). Oxford, England: Oxford University Press.

Institute of Medicine Committee on Advancing Pain. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press (US).

Eccleston, C., Williams, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database System Review, (2): CD007407. Web.

Fillingim, G., King, D., Riberio-Dasilva, C., Rahim-Williams, B., & Rilery, L. Sex, gender, and pain: A review of recent clinical and experimental findings. Journal of Pain, 10(5), 447–485. Web.

Emlet, M. 2005 When It Won’t Go Away: A Biblical response to chronic pain. The Journal of Biblical Counseling. Web.

Green, C., Hart-Johnson, T., & Loeffler, D. (2011). Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer, 117(9), 1994-2003. Web.

Gatchel, J. (2005). The conceptual foundations of pain management: historical overview. In: J. Gatchel (Ed). Clinical essentials of pain management (pp. 3–16). Washington, DC: American Psychological Association.

Gibson, J. (2006). Older people’s pain. Pain Clinical Updates, 3(14). Seattle, WA: International Association for the Study of Pain.

Gupta, A., Weber, N., & Duwell, M. (2013). Implementing a public health approach to the management of chronic pain in the USA. Pain Management, 3(4), 315-319. Web.

Harvard Mental Health Letter. (2004) Depression and pain: Hurting bodies and suffering minds often require the same treatment. Web.

Hoffman, M., Papas, K., Chatkoff, K., & Kerns, D. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health Psychology, 26(1), 1–9. Web.

Institute of Medicine Committee on Advancing Pain. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press (US).

Katzman, M., Pawluk, E., Tsirgielis, D., D’Ambrosio, C., Anand, L., Furtado, M., & Lorio, C. (2014). Beyond chronic pain: How best to treat psychological comorbidities The Journal of Family Practice, 68(5), 260-264. Web.

Nestoriuc, Y., & Martin, A. (2007). Efficacy of biofeedback for migraine: a meta-analysis. Pain, 128(1–2):111–127. Web.

Roditi, D., & Robinson, M. (2011). The role of psychological interventions in the management of patients with chronic pain. Psychology Research and Behavior Management, (4), 41 -49. Web.

The English Standard Version Bible. (2009). New York: Oxford University Press.

Thomas, E. (2010). Pain in older people. In: P. Croft, M. Blyth, & D. Van der Windt (Eds). Chronic pain epidemiology: From aetiology to public health (pp. 186–199). Oxford, England: Oxford University Press.

Turk, D., Swanson, K., Tunks, E. (2008). Psychological approaches in the treatment of chronic pain patients when pills, scalpels, and needles are not enough. The Canadian Journal of Psychiatry, (53) 4, 210-3. Web.

Turk, D., & Okifuji, A. (2002). Psychological Factors in Chronic Pain: Evolution and Revolution. Journal of Consulting and Clinical Psychology, 70(3), 678–690. Web.

Kerns, R., Sellinger, J., & Goodin, B. (2010). Psychological treatment of chronic pain. Annual Review of Clinical Psychology, 7, 411-434. Web.

Yucha, C., & Montgomery, D. (2008). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: AAPB.