Some people begin to think of themselves as ‘chronic invalids’ punished by occupational disability and a ruined social life. They may become housebound, adopting a sick role and believe their pain is a warning signal and that they have a significant amount of physical illness despite all medical reassurance. The combination of sick role, health anxiety and resistance to reassurance makes these patients difficult to treat and to rehabilitate.
The pain patient typically uses a number of pain-killing drugs simultaneously, and often a bewildering array of other medication. Chemical dependence is frequent — particularly with the use of pain-killers containing narcotic derivatives such as codeine and propoxyphene such as Digesic and Codral Forte. They have had usually more surgical procedures, often without success, and are constantly searching for a physical cure. Because the patient’s income is usually less than he or she would have earned, the standard of living is often reduced, which puts additional strain on the family.
The pain patient often uses their affliction to tyrannise the family, playing the role of a chronic invalid and arousing guilt feelings.
Pain’s toll in terms of human suffering is remarkable. Of course, there’s no way to price misery. But billions of dollars are spent on medical care or on lost productivity. The chronic pain patient has had medical and surgical costs ranging from $50,000 to $100,000.The record perhaps goes to a 40-year-old labourer, ‘Hector B’, who had 40 pain-operations costing $450,000 — all originating from an injured back which eventually led to:
• A cordotomy — a division of pathways in the spinal cord to give relief from intense pain.
• An amputated leg.
• Phantom limb pain.
• Cingulotomy — a brain operation that cuts nerve tracts in an attempt to control pain.
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