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Chronic Pain, Loss, and Suffering

Chronic Pain, Loss, and Suffering: A Clinical Perspective

Copyright Date: 2004
Pages: 200
  • Book Info
    Chronic Pain, Loss, and Suffering
    Book Description:

    Loss and grief are an inherent part of chronic illness. But while much has been written on grief associated with death and dying, the grief and losses accompanying chronic illness have received relatively little scholarly attention. InChronic Pain, Loss, and Suffering, Ranjan Roy, a leading expert on chronic pain, addresses the complex issues related to loss among those with chronic illness.

    For many patients with chronic intractable pain disorders, the course of their illness is unpredictable and varied. Many seeming losses are transient and can be redeemed over time, for instance, through retraining and physical therapy, but are still serious and pose a challenge to the common understanding of the grief process. Clinical understanding of grief is undergoing a revolution. From its Freudian roots, it is shifting more and more to a social-psychological perspective. The phase-task orientation of grief has come under serious scrutiny, and this book demonstrates some of the problems inherent in that conceptualization in its application to the chronically ill. The author attempts to combine the current state of knowledge through an examination of contemporary literature and clinical application. He presents a series of comprehensive case studies, which together indicate that the key challenge for many patients is loss of self-esteem and control. The chapters deal with a range of losses such as job loss, declining ability to function, loss of family and sexual roles, old age and its related losses, and suicide. Through discussion of the trials and tribulations and successes that chronically ill patients encounter in their journey, this work will assist clinicians in helping patients come to terms with their new reality and establish a renewed sense of self.

    eISBN: 978-1-4426-7294-9
    Subjects: Psychology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Foreword
    (pp. ix-xiv)

    Chronic pain is a prevalent and costly problem for the individual pain sufferer, his or her family, and for society in general. Estimates suggest that 25 to 30 per cent of the population suffer from some chronic pain condition. These figures may be expected to escalate as the population ages and experiences the accompanying pain conditions such as osteoarthritis, osteoporosis, and peripheral neuropathies. Estimates for direct health care expenditures, indemnity costs, lost time from work, and lost tax revenue in the United States range from $150 (U.S. Bureau of the Census, 1996) to $215 billion (National Research Council, 2001). Of...

  4. Preface
    (pp. xv-2)
  5. 1 Loss and Grief: An Overview
    (pp. 3-20)

    John Bowlby′s seminal work (1981a, 1981b) on attachment, separation, and loss, in particular his original conceptualization of loss as being rooted in the mother-child relationship, has found wide application. Concepts of attachment and loss are covered in topics as varied as relocation of the elderly in a rural area to the loss of a limb, to loss of health, or to loss of a spouse.

    First, however, we shall review briefly the original conceptualization of loss and grief as propounded by John Bowlby, its principal protagonist. Bowlby′s treatment of loss had a central source, namely, separation from or death of...

  6. 2 Loss, Sadness, and Depression: Many Faces of Abnormal Grief and Other Complications
    (pp. 21-42)

    In the previous chapter the notion of loss related to health was described both in general and specific terms. We established that loss of a limb or loss of reproductive organs for women, that is, loss of health and functioning, are understandable reasons for the grief that ensues. We also considered the normal grieving process associated with the loss of a limb and the general demythologizing of a strong association between hysterectomy and depression. Yet, loss of health has the potential of producing atypical grief or even psychiatric disorders. The literature on chronic pain shows consistent elevation on the Beck...

  7. 3 Job Loss and Chronic Illness: A Situation of Double Jeopardy
    (pp. 43-61)

    Unemployment in the population with chronic pain disorders is known to be higher than in the general population (Stang, Von Korff, and Galer, 1998; Stratton et al., 1996; Von Korff et al., 1992). Job loss or unemployment is a hazardous event in any person′s life. When job loss is the direct consequence of declining health associated with a chronic condition, and an inability to function adequately in a job, then the negative effects of job loss are multiplied several-fold (Jackson, lezzi, and Lafreniere, 1997). Job loss can be a wholly undesirable event with very unpredictable consequences. In an investigation of...

  8. 4 Declining Health and Functioning: Redefining Identity
    (pp. 62-81)

    The gradual and cumulative loss of all major sources of gratification, largely associated with the loss of one′s perceived roles in life, is the experience of many chronically ill patients. Unlike acute illness, when there is a sudden flight into the sick role, but then resumption of normal activities after a relatively short intermission, chronic illness with its unpredictable vagaries presents almost insurmountable challenges. Some patients do remarkably well in the circumstances, and others fall prey to the only role that remains available to them and that is the role of being chronically sick.

    People define themselves in terms of...

  9. 5 Family Roles: What Is Lost?
    (pp. 82-102)

    This is a continuation of the preceding chapter. Here we are concerned specifically with the loss of family roles. These losses present a serious challenge to chronic patients′ sense of self. We have so far examined loss of work, as well as the implications of both the sick role and the chronically sick role. The family roles are so critical because of their multifaceted nature. As has already been emphasized, we all derive our sense of who and what we are from the performance of our various roles. The significance of our role in our family probably outweighs any other...

  10. 6 Chronic Illness and Sexual Roles
    (pp. 103-123)

    The sexual relationship is generally regarded as an integral part of adult intimacy. Any attempt to separate sexual roles from the more general affection and caring common in any intimate relationship is laden with shortcomings. Yet, many medical conditions such as major depression, diabetes, heart disease, and prostrate conditions, as well as the effects of medications such as anti-hypertensive drugs, or psychological trauma and grief, compromise sexual desire or even eliminate it. Many couples confronted with this problem deal with this loss in a matter of fact way and their relationship does not seem to suffer any adverse consequences. For...

  11. 7 Old Age, Pain, and Loss
    (pp. 124-141)

    Chronic pain is often accompanied by a variety of losses. These may include job loss, loss of mobility, losses associated with parental and spousal roles, loss of social roles, and many others (Roy, 2001). Losses also occur at a personal or existential level, affecting the individual′s self and personal control (Kelly, 1998). These losses add significantly to a patient′s sense of hopelessness and may even lead to depression. Depression and depressive symptoms are relatively common in persons with chronic pain.

    There exists a notion that a common accompaniment of old age is pain. Chronic diseases abound in old age as...

  12. 8 Chronic Illness and Suicide: The Ultimate Loss
    (pp. 142-164)

    Suicide among the chronically ill, although relatively infrequent, does occur. The reasons for suicide in this population are varied, but they tend to fall into two broad categories: (1) existential reasons and (2) clinical depression. In terms of existential reasons, recognition that one′s quality of life is severely compromised through one′s illness and disability, together with the acknowledgment that one is being a burden to others, makes suicide seem like a viable option to ending the misery. Clinical depression, as the literature review will show, is emerging as the single most powerful reason for suicide in this population. The topic...

  13. 9 Grief Therapy
    (pp. 165-185)

    Much of the literature on grief therapy concerns death and dying, as was discussed in an earlier chapter (see Chapter 7). Coming to terms with one′s own death, and working through the process of bereavement after the death of a loved one are the heart and soul of the published material on grief therapy. The overwhelming majority of people come to terms with the grief following the death of someone they have been close to without the benefit of psychotherapy. Grief therapy, which is integral to psychotherapy, becomes necessary only where there are indications that the grieving process has deviated...

  14. 10 Epilogue
    (pp. 186-192)

    The paramount aim in writing this book has been to find some ways in which to convey the sheer variability and complexity that any general discussion of chronic medical illness presents. Chronic illness encompasses a wide and complex array of disorders and an equally complex range of patient responses to them. Many patients with debilitating diseases continue to function at a high level, while at the other end are patients with persistent pain of unknown of origin who become virtually completely disabled. They all experience losses ensuing from their chronic health condition; they all react to their losses in one...

  15. References
    (pp. 193-210)
  16. Index
    (pp. 211-225)