Principles & Practice of Pain Medicine > Part III. Psychological Evaluation and Treatment of Chronic Pain > Chapter 14. Psychotherapeutic Management of Chronic Pain R. Joshua Wootton, Margaret A. Caudill-Slosberg, and Jillian B. Frank

Psychotherapeutic Management of Chronic Pain: Introduction

"When the International Association for the Study of Pain (IASP) arrived at a definition of pain that included the "emotional experience," as well as the "unpleasant sensory experience associated with actual or potential tissue damage,"¹ they were acknowledging the impact of pain on our human capacity for sentience and reflection and, by extension, suffering. By the time pain has become chronic in an individual's life, it has almost certainly achieved the status of a major source of stress. More than merely an unpleasant sensory stimulus, chronic pain can come to affect the whole individual by becoming, itself, the source of a broad range of psychosocial stressors. The following case report illustrates the extent to which this is possible.A 42-year-old married man was referred to a pain management center, 8 months after suffering a work-related, crush-type injury to his hand. His pain, which had been diagnosed as complex regional pain syndrome, type 1 (CRPS-1), had remained intractable to conservative measures and surgical intervention. According to the patient, several trials of medications had left him with uncomfortable mental status changes, and a reparative surgery and several procedures had exacerbated his pain considerably. He reported his distress as "worse than ever" and indicated that he was unable to work or pursue any of his previous recreational outlets. Although his primary care physician and surgeon supported his claim to disability, his worker's compensation carrier's representatives..."