Chronic Pain........Reasoning and Adapting.




There are a number of chronic pain conditions, particularly neurological conditions, which don't offer a reasonable 'cause and effect' explanation naturally, to those who experience them. Mostly, they are 'hidden' conditions, and the suspected cause is usually some unknown, threat to, or impingement upon, the nerve structure, and usually in the spinal area. Perhaps, most common is some vulnerability in the neck area, giving rise to a variety of radiated, or referred, painful distressing symptoms, whether intermittent, fluctuating in intensity, regular, or ever-changing, but always 'chronic' by virtue of the likleyhood of repetition over an extended time span which would not be expected from a more acute condition. Currently, there are also an equal variety of explanations given for these 'hidden source' symptoms which, when combined with an already confusing array of actual symptoms, can only add to the overall confused nature and explanation of the experience.


Perhaps the first step towards achieving a sense of control over any physical condition, is the need to satisfy the reasoning behind why such a condition, or why such symptoms, might exist in the first place. Without some convincing understanding of that platform, any actions taken to remedy or alleviate the symptoms will inevitably lack the kind of sense of purpose which is required to tackle any problem head-on. There must be a 'real' sense of purpose, and there must be some 'real' reasoning to support it. If a patient detects any confusion, or 'unknowing', in the professionals assessments / advice, they will inevitably lessen their required commitment to any suggested treatments. Unfortunately, this gap in the reasoning behind suggested treatments is usually filled with ever-increasing pain relieving medications, which, besides maybe offering temporary relief, really only increase the options for ignoring any attempt to rationalise the problem in a more reasonable way.


Where uncertainty exists, any patient with a 'hidden' condition, will eventually attempt to assume some reasoning on to their predicament, whether right or wrong, usually dependent on their acquired knowledge of their possible condition.....whatever the source. Simply guiding that 'patient reasoning' into as-near-as-possible the right place, may well be the best possible treatment under the circumstances, before taking any 'statistically unproven' treatments into consideration. Unfotunately, most current treatments for these 'hidden' conditions are best-considered 'safe' options, rather than proven remedies. Such is the state of the science at the moment, and the ethics demand a containment of exploratory approaches. To get around this 'stuck in aspic' approach, I'd suggest that merely refining the reasoning behind the explanations for any 'hidden' condition can open doors for the patient to self-explore the issues, based on a foundational rationalisation of most probable causes and effects. Because there is usually an inherent confusion at play, both with operator and with patient, there is also usually a tendency to drift towards medications and other less reasoned options. A sense of control can really only be inspired by means of a solid reasoned platform....offer this to patients, and perhaps they will, in turn, inspire currently restrained treatments to drift towards less considered options with better remedial potential.


Improvements are really only validated by their relevance to patient experience. Perhaps I would also add here that 'knowing' the causes and effects of any problem usually amounts to half the battle in the struggle to contain and control that problem. Also, building treatment strategies based on that reasoned knowledge, usually amounts to taking care of the other half of the battle. Any confusion entering that equation usually amounts to a lessening of determined effort to find solutions. This clarity of understanding really needs to be enhanced before expecting any patient with a 'hidden condition' to respond with any real commitment. And if 'neuro-nudging' is to be believed, then it's probably best that the patient believes they have arrived at a reasoned understanding themselves, despite being nudged there by the craft of the operator ! The reasoning must be self-convincing, perhaps even subliminally self-convincing, before a patient will assume the full challenge of exploratory self-management.