Coping With Neck Pain
Longstanding or chronic neck pain, like other chronic pain syndromes, involves psychological and social aspects. There is an important role of the family as supportive but also potentially counter productive in helping those with chronic conditions in coping with neck pain and to gain independence and control over their pain and suffering problems.
Patients with chronic neck pain or other chronic pain syndromes must understand that there will be flare-ups and that they can, with appropriate understanding and training, learn to cope with them.
Dealing with chronic neck pain may be accomplished on your own, or may require professional help. The philosophy is to provide one with tools for self management and strategies to alleviate the pain and/or suffering.
In the treatment of pain, doctors traditionally focus on a physical basis for the pain, and when a physical basis is not found or insufficient, it is assumed that causation is psychological. Where the pain source is identified, the physical cause is not the only consideration in prediction of pain severity or level of disability. Identical treatments for the same physical conditions often have very different results.
Pain severity does not always predict the amount of psychologic distress or extent of disability. Factors of chronic pain conditions such as depression, sleep disturbances, social and occupational impairments were assumed to be of secondary consequence and likely to disappear once the condition was cured. The continuation of pain that was not “cured” by medical, therapeutic or surgical methods, the variation in treatment response, and disability of function in excess of what might be expected based on physical findings, all contributed to developing a more comprehensive model of pain.
There has been an understanding of the important role played by psychological factors on the sensation of pain. It has been shown that psychological factors are capable of influencing physiological states and that people can learn to control important physiological functions associated with pain and stress.
An integration of these insights have led to the development of a more comprehensive model and approach to chronic pain treatment called the cognitive-behavioral approach which is applied to all types of chronic pain syndromes which emphasizes illness. Illness is the subjective experience that disease is present, resulting in physical discomfort, emotional distress, limitations of function and psychosocial disruption. It addresses how the patient, family members, and the social network around them receive and respond to the consequences of the symptoms from coping with neck pain.
Psychologic factors of pain include depression, anxiety, and anger. These emotions can cause a chain reaction of increased release of adrenalin and norepinephrine and activation of damaged or sensitized nerves which increases pain. These emotions may also lead to decreased energy and motivation to participate in treatment which can complicate rehabilitation.
Cognitive processes such as beliefs about the cause of the pain being undetected and malignant, unrealistic goals for therapy, negative thinking styles such as catastrophizing, inadequate coping strategies, and lack of a sense of self-worth can make treatment ineffective and can contribute to significant increases in pain. Nervous system activation, increased muscle tone, spasm, and pain are all direct effects of these cognitive factors.
Social factors also have a great impact on the pain experience and response to treatment. These factors include social learning factors, sources of pain reinforcement, current stressors, and compensation or litigation issues. Social learning factors are the attitudes about health, pain, and appropriate responses to injury or illness. Children of chronic pain patients tend to feel less control over their health.
Pain behaviors include the avoidance of averse situations or activities, such as doing housework, returning to a job that was disliked, or personal relationships. Reinforcement of pain behaviors may result from the anticipation of pain and therefore immobilization or deactivation of the affected part. Although the avoidance of increased pain may be beneficial initially, the consequence is long term loss of strength, energy, or function.
Along with pain or disability, a patient may be trying to cope with the illness, death, divorce, or another negative event in the life of a family member or close friend. Financial problems, social isolation, cognitive limitations from medications, or other life problems combined have drained methods for coping neck pain and may affect the ability to benefit from treatment. Compensation or litigation issues may interfere with treatment if it is believed that improvement will result in decreased financial benefit.
In most cases medical or therapeutic interventions are enough to alleviate the pain, however, over time psychosocial and behavioral factors can serve to worsen and maintain pain and to influence adjustment and disability. The earlier a potential factor is identified, the less likely it is to influence response to treatment. These factors are often present in managing chronic conditions like whiplash.
A 2019 study in the Spine Journal indicates psychosocial risk factors may be a predisposition in the progression of neck pain to chronic pain and/or disability. The authors found low resilience (ability to recover from stress) and pain self-efficacy (confidence in performing daily activities despite pain) are important psychometric properties shown to affect health and illness.
There are four components that comprise pain management treatment in this psychosocial perspective to coping with neck pain. These four components are interrelated:
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