Published Papers by Dr. Benjamin Hirsch

People visit a doctor for pain more than for any other symptom. On any given day, 7 million people in this country are being treated for this problem. Some pain is acute, meaning that it will resolve rather quickly, but much of it is chronic, present for long periods of time even though an injury is long healed or many kinds of treatment have been tried. For many people who feel chronic pain, the suffering is continuous. Waking and sleeping, they are preoccupied with it. They want it removed by any means. Often, surgery is tried, sometimes more than once. Unfortunately, in many cases, the pain returns. Medication provides some help, but often larger and larger doses are requried to maintain relief. Chronic pain affects the marital relationship. Patients tend to have poor relationaships with their spouses and show poor sexual adjustment. One study found that 20 percent of spouses of pain patients reported significant symptoms of depression, and over 35 percent rated their marital adjustments as poor. Serious depression, known as major depression, is present in about 25 to 50 percent of all pain disorder patients, and most of the others show some depressive symptoms. Many of these aptients self-medicate using alchohol or illegal drugs in a desperate attempt at alleviating their pain. Besides pain causing psychological symptoms, pain can be a way of expressing psychological problems. For many people, it carries less stigma to complain of something hurting than it does to admit anxiety or deppression. A professional consulted by a person in pain must accept that the suffering is real. Many patients in chronic pain are unfortunately misunderstood or not accepted. Their physician understands pain only as it relates to a definite physical cause. A substantial number of patients, however, challenge physicians with persistant complaints of pain for which no physical origin can be found. Physicians tend to become frustrated with such patients, and dismiss them as "crocks". This is just another exapmle of blaming the victim when the truth is we do not fully understand the condition of chronic pain. At present, we don't have an adequate common language and categorization system to help pinpoint an individual's pain. One of the pioneers in pain research, Ivan Illich, wrote, "Just as my pain in a unique way only to me, so I am utterly alone with it. I cannot share it. I have no doubt about the reality of the pain experience, but I cannot really tell anybody what I experience." In order to help people with chronic pain, we must find a way to understand what they are experiencing. When physicians can't find a definite physical cause for pain, they refer for psychological evaluation with the implication that "It's not real, It's all in your head". Most patients find this interpretation to be critical, and react to it with anger and defensiveness. Not only does this have a negative effect on the physician-patient relationship, but it may also contribute to a negative attitude on the part of the patient towards seeking psychological services. If a patient interprets a psychological referal as meaning that he or she is "crazy" or does not have a legitimate pain problem, the person will feel dumped by the "real" health care system. Moreover, if compensation or litigation issues are present, patients are concerned that they are being viewed as malingerers. A psychologist can begin to bring hope and relief to the patient by believing and accepting the patient's suffering, and by teaching various skills, such as relaxation, that have been shown to bring some relief. Once a patient's physical discomfort is accepted and coping skills mastered, an oppurtunity will occur so that the patient and therapist can focus on other emotional issues that may be related to the pain.