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Holistic Nursing Practice:
Continuing Education

Understanding Chronic Pain and the Mind‐Body Connection

McCaffrey, Ruth ARNP, ND; Frock, Terri L. EdD, MSN, ARNP, BC; Garguilo, Heidi MSN, ARNP

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Abstract

This article investigates the mind-body connection in chronic pain. A discussion of pain physiology is designed to identify the role of the neurological system in chronic pain perception. The gate control theory and the neurotransmitter theory of pain are explored. A description of mind-body and pain management methods, and an illustrative case study are provided. The information presented concerning mind-body connection in chronic pain perception will enable practicing nurses to be more fully aware of the chronic pain phenomenon, and lead to better chronic pain assessment, management, and evaluation.

Pain affects people of all ages, socioeconomic groups, and ethnic backgrounds. In fact, pain is the most common chief complaint in primary care, with chronic pain reported in 20% of the visits to primary care providers. 1 Traditionally, the focus of pain inquiry has been primarily biological, often ignoring psychological, emotional, and cultural differences inherent in pain perception. The mind-body connection of chronic pain underscores all of these factors with the explicit understanding that while external forces create a biological cascade of pain sensation, cognitive awareness and emotional response contribute to the chronic pain experience. 2 Chronic pain can produce feelings of hopelessness and helplessness that exacerbate pain perception. Some emotional responses to chronic pain such as anger and stoicism are personal coping strategies to distract the mind from the perception of chronic pain.

Not recognizing the mind-body connection in chronic pain management can result in suboptimal patient outcomes. Katz 3 identified that a patient's pain symptoms are influenced by the health care practitioner's actual attitude toward pain. Furrow 4 reported that chronic pain often is undertreated and poorly managed in all health care venues of the American health care system. These findings compel advanced practice nurses to consider chronic pain and its management using knowledge of pathophysiology, psychology, and the mind-body connection. Not understanding the patient's past pain experiences, current emotional state, and personal and cultural meaning of pain can greatly decrease the health care provider's ability to assess and treat the patient's chronic pain.

Managing pain involves accurate assessment, adequate intervention, and frequent evaluation. 5 Every advanced practice nurse is affected by the challenge of accurately assessing and relieving chronic pain. The goal of this article is to assist advanced practice nurses to better understand the physiologic causes of chronic pain and the mind-body connection that controls the way chronic pain is perceived, and apply the mind-body connection to an actual patient situation.

© 2003 Lippincott Williams & Wilkins, Inc.

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