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Related To This Are The Theories Surrounding Autonomic Arousal, Which Have ...

Related to this are the theories surrounding autonomic arousal, which have also received empirical backing. It has been asserted that patients suffering from chronic pain do not respond to pain in the same ways as patients whose pain is not chronic. This is true despite the fact that they do not demonstrate significant differences from non-chronic pain patients in other areas. When the responses of chronic pain patients are measured with regard to distressing activities, the pain levels measured increased dramatically. This was not true for normal activities. Therefore, it seems safe to adhere to a model of chronic pain in which the state of arousal prompted by particular activities directly affects the pain experienced by the patient.
Other elements in the cognitive behavioural model have also received support. In particular the role of medication and the appropriateness of use can affect patients' complaints regarding symptoms and level of incapacity. One study examined the contrasting characteristics of chronic pain for patients whose pain could be justified by medical explanations and those whose pain could not be explained in medical terminology. The authors found remarkable variations in a number of variables, such as excessive prescribing and internal processing in the group of patients whose pain could not be medically explained. They went on to assert that when medical professionals in this type of situation intimate that it could be psychosomatic, they reinforce the patient's self-concept of an ill person, if not physically, then mentally. Reacting in this fashion often fails to convince the patient that there is nothing wrong and instead, motivates their search for a plausible explanation for their pain. They may demand more tests and interventions in search of legitimising their pain. The important point here is that the responses of medical professionals to patient expressions of pain can have a significant impact on pain-related cognitions and thus on their responses to treatment.
The sum of this evidence provides legitimisation for approaching chronic pain in a way that is much like the way that anxiety and obsessions are approached. This suggests that if obsessions can be treated, then so can maladaptive pain-related cognitions and behaviours. While the need for further research remains in certain areas, such as the clarification of the significance of safety behaviours and the effectiveness of specific cognitive behavioural intervention programmes, there is strong evidence that cognitive behavioural treatments will overtake operant treatments as the preferred method for addressing chronic pain. Sharp (2001) concludes his discussion of psychological theories of chronic pain by arriving at the destination of cognitive behavioural models akin to those used to treat anxiety.

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