Biopsychosocial model of chronic recurrent pain

Abstract

Bolečina ni le znak bolezni, večkrat je povsem samostojen pojav, ki pa je vselej povezan s psihološkimi dejavniki (Sternberg, 1973). Posebno o kronični, ponavljajoči se bolečini, ki se postopno razvije kot sindrom fizioloških, psiholoških in vedenjskih sprememb, v odvisnosti druga od druge, je treba razmišljati v tej smeri. V raziskavo smo naključno zajeli 50 oseb s tenzijskim glavobolom, ki so v zadnjem letu večkrat iskali zdravniško pomoč. Preverili smo jakost njihove bolečine, njeno trajanje, obseg doživetih obremenitev in potrebnih prilagoditvenih poskusov, konstitucionalne oziroma temperaturne značilnosti načine spoprijemanja, osebnostne poteze, vlogo bolečine v intra in intersubjektnem komuniciranju. Rezultate smo s pomočjo multivariatne analize variance (MANOVA) primerjali s kontrolno skupino in podatke testirali z analizo variance. Oseba, ki trpi in pričakuje pomoč, je v naši skupini največkrat ženska, poročena, z osnovnošolsko ali srednješolsko izobrazbo, stara okrog 40 let. Kot kaže se bolečina pojavi v stanju stresne izčrpanosti, ki pa ni odvisna le od ocene doživetih obremenitev ter poskusov razrešiti jih, pač pa tudi od konstitucijsko šibkejšega živčnega aparata teh oseb in njihovega manj učinkovitega sloga spoprijemanja s problemi. Pomemben dejavnik vztrajanja bolečine se skriva v njihovi odvisnosti od socialnega polja pa tudi v odzivih drugih oseb (zdravnik, partner). Pomembno je, da se v obravnavi oseb s kronično bolečino, posebno še tistih s tenzijskim glavobolom, naslonimo na bio-psihosocialni model bolečine ter take osebe vključimo v integrativno terapijo, katere del je tudi psihološka obravnava. Vloga psiholoških dejavnikov v pojavnosti bolečine mora biti zato jasna, saj tudi tako lahko preprečimo kronifikacijo pojava.Pain is not merely a symptom of disease but a complex independent phenomenon where psychological factors are always present (Sternberg, 1973). Especially by chronic, recurrent pain it\u27s more constructive to think of chronic pain as a syndrome that evolves over time, involving a complex interaction of physiological/organic, psychological, and behavioural processes. Study of chronic recurrent functional pain covers tension form of headache. 50 suffering persons were accidentally chosen among those who had been seeking medical help over more than year ago. We tested their pain intensity and duration, extent of subjective experience of accommodation efforts, temperament characteristics, coping strategies, personal traits, the role of pain in intra- and interpersonal communication. At the end we compared this group with control group (without any manifest physical disorders) and with analyse of variance (MANOVA). The typical person who suffers and expects medical help is mostly a woman, married, has elementary or secondary education, is about 40. Pain, seems to appear in the phase of stress-induced psychophysical fatigue, by persons with lower constitutional resistance to different influences, greater irritability and number of physiologic correlates of emotional tensions. Because of their ineffective style of coping, it seems they quickly exhausted their adaptation potential too. Through their higher level of social-field dependence, reactions of other persons (doctor, spouse) could be important factors of reinforcement and social learning processes. In managing of chronic pain, especially such as tension headache is, it\u27s very important to involve bio-psychosocial model of pain and integrative model of treatment. Intra- and inter-subjective psychological functions of pain must be recognised as soon as possible

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