Pain Management

by

Terry Altilio, Maris Pasquale Doran, Meagan Lyon Leimena

• LAST REVIEWED: 27 October 2016
• LAST MODIFIED: 27 October 2016
• DOI: 10.1093/obo/9780195389678-0242

Introduction

Pain and its complexity are reflected by the myriad persons who suffer with pain and also by the variety of specialists whose attention has been captured by pain and its impact. Those who have attended to the study, mystery, and treatment of pain include philosophers and healers, spiritual leaders, mental-health professionals, scientists, policy experts, regulators, legislators, and litigators. The rich pain mosaic has been slow to engage the social work profession, and thus many of the abstracts presented will be the work of inter-professional colleagues who have created a context that social workers can build on and enrich. Social workers in many areas of the world are the first line of mental health providers in health settings providing an opportunity to impact the lives of persons who experience pain and the settings in which they receive care.

Introductory Works

As early as 1979, articles in social work literature focus on the unique needs of persons who live with pain, their families, and the contribution that social work might make to this multidimensional health problem (see Golden and Steiner 1981). As the global nature of pain’s psychosocial effects was recognized, the social work perspective seemed especially relevant. Comprehensive assessment of emotional, familial, social, and environmental issues and the relationship to the pain experience led to interventions that might influence the individual and family, and mediate intrapsychic conflicts and sociocultural factors (see Roy 1981). In the late 1980s and early 1990s, chronic pain and the relationship to family systems captured the attention of clinicians who were interested in both impact and effectiveness of interventions (see Roy 1989). Social work authors contributed to the evolving specialty in varied ways. Some medical social workers identified pain as a priority focus, advocating an ecological model (see Subramanian and Rose 1988). A model based on systems theory was proposed to capture a visual representation of the complexity of interacting factors that contribute to the chronic pain experience (see Marcus 1986). Attention to the social work perspective and to the complexity of pain as a clinical, policy, ethical, economic, and social dynamic and an evolving advocacy movement is reflected in challenges to behaviorally based treatment approaches (see MacDonald 2000). An early survey of social workers in Canada addressed attitudes and knowledge related to pain as it became recognized that social workers were providing services in many settings that created the potential to impact chronic pain clinically and through research (see Sieppert 1996).

• Golden, J. M., and J. R. Steiner. 1981. Unique needs of people with chronic pain. Health and Social Work 6.3: 47–53.

  This article discusses the individual, societal, and professional response to a multidimensional health problem that is cloaked in stigma and considers the increased vulnerability by virtue of minority or poverty status or gender as well as the potential for cultural variation in the pain experience.

• MacDonald, J. E. 2000. A deconstructive turn in chronic pain treatment: A redefined role for social work. Health and Social Work 25.1: 51–57.

  DOI: 10.1093/hsw/25.1.51

  Advocating as social worker, educator, and person living with pain, this author advocates social work values and suggests a reevaluation of treatment approaches that focus on the management of behaviors and applies a process of “deconstruction” to the contingency management model.

• Marcus, M. 1986. Chronic pain: A social work view. Social Worker-Le-Travailleur-Social 54.2: 60–63.

  Proposes a model that uses a systems map to exemplify and assess pain as a part of a person’s reality influenced by many factors including physical limitations, the patient’s emotional response, and those of others (including health-care professions), psychosocial stresses, and financial issues.

• Roy, R. 1981. Social work and chronic pain. Health and Social Work 6.3: 54–62.

  This comprehensive application of the person-environment paradigm to pain links person-family-centered assessment to multidimensional interventions and expected outcomes, advocating for the role of social work clinicians in pain programs while acknowledging the absence of research documenting outcomes.

• Roy, R. 1989. Annotation: Chronic pain and the family: A review. Journal of Family Therapy 11:197–204.

  DOI: 10.1046/j.1989.00345.x

  This review focuses on the state of the literature and research related to chronic pain, the impact on family, and the effectiveness of family therapy interventions.

• Sieppert, J. D. 1996. Attitudes toward and knowledge of chronic pain: A survey of medical social workers. Health and Social Work 21.2: 122–130.

  A study of 212 medical social workers suggested that a positive orientation toward involvement in chronic pain services is not matched by the knowledge base of medical social workers, a need that can be addressed by individual practitioners and educators.

• Subramanian, K., and S. D. Rose. 1988. Social work and the treatment of chronic pain. Health and Social Work 13.1: 49–60.

  Recognizing the relationships between physical, emotional, and cognitive factors in the experience of pain these authors offered cognitive behavioral coping skills training in an outpatient group setting.