TYPES OF PAIN: ORGANIC PAIN WITH FUNCTIONAL OVERLAY
For descriptive purposes it is often convenient to consider pain as either organic or functional. But like many things in nature this pigeonholing of ideas is not completely valid. It is not quite as simple as that. Thus pain that is caused in the first place by some disease or injury soon produces a psychological reaction. It causes the patient to worry. He may worry a lot, or he may worry a little. The degree to which he worries will depend upon a great number of factors—the nature of Ills personality, and whether he somehow feels bad about his condition, or whether he blames himself for having caused it, or whether he feels that in being sick he has let down his family or others for whom he feels responsible. Psychological factors such as these influence the severity and duration of the pain. This is the psychological overlay that may accompany a pain which is classified as organic in origin in that it was primarily caused by stimulation of nerves by disease or injury. In fact, the psychological overlay may be the major factor in producing the pain in these cases, and it is not uncommon for the psychological overlay to maintain the pain long after any physical cause for the pain has ceased to operate.
This mechanism is often seen very clearly in cases of injury involving compensation. A man is injured at work. He knows that he is entitled to monetary compensation, but he does not know the exact figure until his claim is settled. The injury heals, but the pain persists. Sometimes the pain even gets worse. In spite of this he looks fit and well, but people near to him come to notice that his thoughts keep returning to this question of his claim for compensation. Doctors who examine him can find no cause for his pain, and they are inclined to regard him as malingering. Of course, everyone knows that cases of malingering do occur, but these represent only a small minority. The pain is determined unconsciously by the functional overlay without the patient having any real awareness as to what is happening. When no compensation is concerned patients recover from similar injuries without the same prolongation of the pain. Sceptics point to the fact that the pain clears up miraculously when the claim is settled, but this does not disprove the unconscious cause of the condition.
A man about forty-five years old was referred to me by his local doctor. The patient suffered from definite but mild rheumatoid arthritis. The local doctor was puzzled by the recent increase in the degree of pain suffered by the patient. It was little influenced by pain-killing drugs, and was on the point of ruining the patient’s life.
The patient’s wife was childless. Twenty years ago they had taken a baby girl to live with them. They had brought her up as their own, but the child’s parents had never allowed them to adopt her. The girl was now to be married and the real father had come to take his place at the ceremony. The patient was tense, bitter, resentful, and full of unexpressed hostility. His tension had provided the functional overlay to the organic pain.
A childless woman of fifty had had minor surgery three years previously. She complained of pain in the scar. She had sought help from overseas specialists to no avail. She used the following words to describe her condition: “Feels like a knife or something sharp. Like a metal plate. Conscious of it all the time. It is an inhuman sort of pain. It aches at the base of the incision. Stiff and sore as if bruised.”
She was a shallow society woman without any real sense of values, who for years had tried to escape life in an endless round of parties. Now she was older and no longer beautiful. She saw her friends with their children. The hurt of it all came to her, and she felt it in the scar of the operation.
I did not put these ideas to her. To do so would have been cruel, and would have made her worse by mobilizing her anxiety. It is usually unwise to tell people the cause of their trouble in so many words, much better to let it come indirectly; then they understand and know it to be true. This happened with this woman. She changed during the weeks she was doing the exercises, and it was clear that she achieved some inner acceptance of things in a way that is not uncommon when people come to do the exercises in meditative fashion. At the same time the pain subsided and she was able to resume a more active life.
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