Psychological and Psychiatric Aspects of Pain Management

Bol je velik zdravstveni problem. Velik broj ljudi diljem svijeta trpi kroničnu bol. Bolna stanja mogu biti posljedica tjelesne, katkada neizlječive bolesti, mogu biti povezana s ozljedom, upalom ili drugim oštećenjem tkiva, a jačinom većom od očekivane. U određenog broja pacijenata s boli stručnjaci ne mogu utvrditi uzrok. Neobjašnjiva stalna bol može biti klinička prezentacija nekog od psihijatrijskih poremećaja. Bez obzira na podrijetlo, bol utječe na razinu aktivnosti, primjerice radno i socijalno funkcioniranje te može biti ne samo osobni teret nego i teret društvu. Na bol utječu osobne, socijalne, okolišne varijable ukljucujuci karakteristike licnosti, spol, rasu, socioekonomski status. Pacijenti s kroničnom boli i dalje su težak dijagnosticki i terapijski izazov te bi liječenje boli trebalo biti multidisciplinarno. Uz farmakološki tretman koji može uključivati antidepresive, antikonvulzive i atipicne antipsihotike u cilju smanjenja anksioznosti, depresije, ali i same boli, trebalo bi uključiti psihološke i psihosocijalne intervencije kako bi se smanjila emocionalna patnja. Dio holističkog pristupa može biti kognitivno-bihevioralna terapija s aditivnim ucinkom na ostale oblike tretmana. Psihološki pristup može smanjiti stres, napetost, ljutnju, bespomoćnost i negativne posljedice boli na svakodnevne aktivnosti, s poboljšanjem kvalitete života kao krajnjim rezultatom.Pain is a significant healthcare problem. A great number of people around the world suffer from chronic pain. A painful condition may be a result of somatic and sometimes even incurable diseases, but it may be also associated with injury, inflammation or other tissue damages that are more intense than expected. In a certain number of pain patients, healthcare professionals cannot identify its cause. In these cases, where constant pain cannot be medically explained, it may be a clinical presentation of a psychiatric disorder. Whatever its origin, pain affects activity levels, e.g. work and social activities, and it can represent both a personal and societal burden. Pain is influenced by personal, social and environmental characteristics, including personality, gender, race, socioeconomic status and physical environment (e.g. weather and climate). Chronic pain patients remain a difficult diagnostic and management challenge. Chronic pain requires a multidisciplinary treatment. Besides the pharmacological treatment that can include antidepressants, anticonvulsant drugs and atypical antipsychotics to alleviate both anxiety and depression and the pain itself, psychological and psychosocial interventions can be practiced in order to relieve pain and emotional suffering. Cognitive-behavioural therapy could be a part of a holistic approach to treating chronic pain patients. It has additive effects to medical therapies. Psychological approach can reduce stress, tension, anger, hopelessness and negative consequences on daily activities, and improve the quality of life