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from a medical specialist, even though there are many psychological
aspects, which we will discuss below.
For many individuals, stress seems to exacerbate pain in specific
parts of the body. So, it isn't surprising that there is a connection
between headaches and mental/emotional disorders. For instance,
Migraine sufferers have poorer coping strategies (wishful thinking and
excessive self-criticism) and have more panic attacks than people
without headaches. Likewise, fibromyalgia patients (88%) have more
psychological disorders than other sufferers with equal pain, like
arthritic patients (30%). Fibromyalgia patients, who's pain pathways in
the brain respond strongly to just moderate pressure, are also more
likely to have been abused as children and physically assaulted as
adults than arthritis sufferers. Thousands of factual tidbits are coming
together, such as the frequency of migraine headaches has almost
doubled between 1981 and 1989 (a diagnostic fad?) and women have
more migraines than men (for women consider the time of the
month). Given enough information, the scientific understanding of pain
will become clear. That doesn't mean we will be able to stop all pain.
Pain patients who also have certain kinds of psychological
problems respond to pain treatment differently. For instance,
psychologists (e.g. Turk & Gatchel, 2002) specializing in treating
chronic pain patients suggest there may be three subgroups: (1) the
"dysfunctional" have severe pain, tend to be depressed and inactive,
and feel they have little control over their pain. (2) The
"interpersonally unhappy" are in serious pain and feel they are
discounted and unsupported by people around them. (3) The "more
optimistic copers" have pain but handle life's problems and continue to
have hope of controlling their pain. Dr. Turk found that fibromyalgia
patients in group (2) did not benefit from standard pain treatment
(education, exercise, stress management training), but patients in
groups (1) and (3) did benefit. Maybe group (2) needs more help with
their interpersonal problems. Indeed, other therapists have found that
including others (family or spouse) in the treatment of pain helps the
patient...and the relatives (Siri Carpenter, APA Monitor, April, 2002).
Pain treatment needs to be individualized, one approach doesn't fit all.
Perhaps 50 million Americans suffer chronic or frequent pain. Yet,
there are great barriers to getting treatment (in addition to our
ignorance). (1) Some patients are afraid of being seen as wimps;
others worry they may have a serious disorder, like cancer, and don't
want to know; some unrealistically fear taking pain-killers, like
morphine; others fear the pain is mental or feel their doctor thinks it
is. (2) Physicians are not trained in Medical School to handle pain;
thus, this isn't their specialty and they are often uncomfortable,
especially if the patient doesn't get better. They can get in legal
trouble if they over- or under-prescribe. (3) Many managed care and
health insurance programs try to avoid paying for expensive pain
treatments. Patients may feel better on pain-killers but they often
don't go back to work. Thus, there are many reasons people in pain
don't get adequate treatment, especially children, the elderly,
