Five Steps to Mindfulness
Ces, such as medical systems, disability insurance, religious beliefs, and cultural attitudes. There is also a crucial role in human pain played by human consciousness. We know more about what disability insurance and religious beliefs contribute to pain than about the slippery contributions of human consciousness.
Pain is commonly explained as the result of a series of specific sensory processes in the nervous system. The results of these sensory processes are presented to conscious awareness. Cognitive psychology is concerned with the interaction between environment, the emergence of pain into awareness, and the consequences of being aware of pain. Pain acts to interrupt current concerns with a danger signal. We have a good understanding of the interruptive characteristics of the pain stimulus. The more intense, novel, unpredictable, and associated with danger a pain is, the more interruptive it is. Similarly, pain stimuli that are more associated with threat, due to either learning or the immediate context, will be more interruptive.
There is a 40-year history of development in the behavioral and cognitive approaches to chronic pain, beginning with the operant approach,1 including the cognitive-behavioral approaches,2 up to the present day. As this history continues, any description of the psychological effects of chronic pain will be a snapshot in time and in a process of change. It is fortunate for this purpose, however, that interest in the contributory causes of chronic pain has been more changeable over time than interest in the effects of chronic pain, which has tended to yield greater consensus. In other words, psychologists and other professionals have considered an ever wider range of variables in the search for where suffering, disability, and life disruption come from, as opposed to what they are made of or how significant they are. If there is doubt about these trends, notice our changing interest in conversion disorders, pain behavior, reinforcement, social support, and responses from significant...
Withdrawing socially, and using assistive devices can be behavior patterns that serve only as attempts to limit contact with pain, and do not serve purposes the pain sufferer would otherwise rate as most important and meaningful in their life. In essence, dealing with pain can move an individual, unwittingly, away from what they care about most. Part of this process can be referred to as a values failure or a failure of values-based action.71 We have found that patients with chronic pain rate their success at living according to their values in areas of family, intimate relations, friends, work, health, and growth or learning, as significantly lower than the level of importance with which they hold their values in these domains.72 We have also found that the losses that come with the failures of values to guide action contribute to significant anxiety, depression, and disability in patients with chronic pain. Additional analyses in this same study demonstrated that both acceptance of...
Pain clinics in the United States frequently utilize mindful therapies (MT) for patients with pain because they have been found experientially to be beneficial. Frequently, nurses or psychologists receive training in one or more of these therapies and teach the patients to utilize them on a regular basis, for both prevention of pain and to manage pain flares. These therapies include relaxation breathing, meditation, mindfulness-based stress reduction (MBSR), self-hypnosis, guided imagery, autogenic training, and progressive muscle relaxation (PMR).79
Active treatment of neuropathic pain can be either for long-term management or for acute flare-ups of pain. It is hoped that administration of medication on an ongoing basis may have a prophylactic effect in that it may curtail the frequency, magnitude, and duration of any flare-ups. When medication is used in the long term it should be chosen because of its tolerability being mindful that side effects of medication can be of slow onset and insidious as well as immediate and obvious.
Mindful CAM therapies include relaxation breathing, meditation, mindfulness-based stress reduction, self-hypnosis, guided imagery, autogenic training, and progressive muscle relaxation. Therapeutic touch, healing touch, Reiki, Qi Gong, and shamanic healing are all examples of energy healing therapies. These therapies are based on the construct that energy flow can be manipulated by practitioners and brought into balance to induce healing and pain relief.
The difficulties in obtaining optimal pain relief in CP conditions by pharmacologic intervention emphasize the need for a multidisciplinary approach. Nonpharmacologic treatment regimens including physiotherapy, cognitive and behavioral therapy are often used. Norbrink et al. 59 performed a non-randomized study, in which a multidisciplinary pain program was evaluated in patients with SCI and neuropathic pain. The 10-week program included educational sessions on pain physiology pharmacology, behavioral therapy, relaxation techniques and body awareness training and included 27 patients with SCI. A control group consisting of 11 patients with neuropathic pain was included. At 12-month follow-up no effect was seen on pain intensity, but the level of anxiety and depression decreased. Other methods such as hypnosis may also be useful.
A 50-year-old female was admitted with a history of alcohol abuse, onset of jaundice, fatigue, nausea, vomiting, and dark urine. There was no history of contact with hepatitis or of intravenous or intramuscular medication. On admission, she had spider nevi and ascites. The diagnosis was acute alcoholic hepatitis. Her condition deteriorated after admission and she became comatose and unresponsive. After remaining comatose for two days, her condition was considered as terminal and with the insistence of her relatives she was referred by her physician to me for possible hemoperfusion since nothing else could be done. One hour after hemoperfusion, she started to regain consciousness and began to recognize her relative and answer questions in sentences. Hemoperfusion was carried out for a total of 80 min. She remained conscious for about an hour after the end of the hemoperfusion, but lapsed into coma again. Three days later she was still comatose, and a second hemoperfusion was initiated....
Thus, people do not possess stories the way they possess, say, a virus or a suitcase. As Remen carefully phrases it, people do not have stories, they are stories. As one loosely affiliated group of psychologists puts it, human experience and human identity are inherently storied. If you subtract my stories from my personal identity, so this argument runs, you get zero. Zero includes a living organism, but nothing that most patients would recognize as fully human. Remen's assertion, presumably based upon observation inside and outside the clinic, draws support from various investigators looking into the construction of human consciousness. Together such lines of thought suggest that it makes good sense to weigh the evidence provided by patient narratives, especially in cases of intractable pain. Where causes are often elusive and treatment vexed, anecdote constitutes not just
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