Representing clients suffering chronic pain, the interaction between their pain and their psychological state is not always apparent. People will naturally try to put on a ‘brave face’ for the benefit of family and friends and, in all likelihood, for their legal representative as well.
There is also very often a natural reticence to discuss their mood and feelings, lest there be some assumption that in some way their debilitating chronic pain is all in their mind.
However, it is fairly obvious that chronic pain is going to take its toll psychologically. How can it not? Indeed, many sufferers find that the effect on their mood and feelings worsens to the extent that they become clinically depressed, sometimes severely. The stress and depression becomes all-consuming and can serve to worsen the pain. The increase in their pain worsens their depression, which in turn worsens their pain, creating a vicious downward cycle which can be difficult to break.
It is perhaps important at this stage to understand the difference between a ‘Chronic Pain Syndrome’ and a ‘Chronic Pain Disorder’ and the possible interaction between the two.
‘Chronic Pain Syndrome’ is a generic term usually used to refer to persistent pain which has a readily identifiable physical cause. ‘Chronic Pain Disorder’ on the other hand, is a term applied to persistent pain where there the cause is thought to be psychological. In other words, the pain is absolutely genuine, but there is no clear physical cause.
As a result of the psychological impact of living with persistent pain, people diagnosed with a chronic pain syndrome such as CRPS / RSD may additionally go on to develop a chronic pain disorder, which can serve to further entrench their pain, making it more therapy resistant. It is for this reason that a multi-disciplinary approach to treatment is so important; the physical and the psychological must be treated concurrently.
The depression is usually treated with a combination of antidepressant medication, commonly Selective Serotonin Reuptake Inhibitors (or SSRIs), and therapy – Cognitive Behavioural Therapy (CBT) and/or Eye Movement Desensitisation and Reprocessing (EMDR).
It is always important in the context of a claim that the cost of future treatment is accurately quantified and included. This is particularly important for psychological treatment as it is a sad fact that a high proportion of people treated for depression will suffer further relapses.