Many health care professionals fail to recognize the complexity of pain and believe it can be identified by the presence or absence of physical findings (e.g. tissue damage), prior emotional problems or secondary gain (e.g. not wanting to work), which is rare. As a result, countless individuals have been informed that “the pain is in their head,” while the fact is that one out of every four Americans suffer from some form of chronic pain, according to the American Chronic Pain Association.
Properly diagnosing a chronic pain patient is often very difficult because of confusion etween four different types of pain assessments. Pain is often evaluated by looking at the following:
- Nociception – ongoing tissue damage stimulating pain receptors. Most standard medical tests are designed to detect such damage
- Pain behaviors – outward signs of pain (crying, limping, withdrawing, hostility, obsessions, etc.)
- Suffering (depression, anxiety, anger, cognitive problems, addiction, boredom etc), which might not correlate with physical findings and is treated inappropriately by giving the patient pain medication or even surgical procedures.
- Pain perception (ratings from 1-10), quite valid for assess for pain medication.
However, these four different aspects of pain assessment often lead to over-prescribing of medication and/or surgery and the under-prescribing of biofeedback, physical therapy, individual, family and group therapy and other mind-body therapies which are often referred to in a derogatory manner as ‘alternative therapies’.
Chronic pain is a complex disorder and patients are often accused, directly or indirectly, of being malingerers, neurotic, psychosomatic or lazy and avoiding work. The corellation between physical findings (e.g. CT, MRI, X-ray results) and pain complaints are fairly low (40%-60%). Individuals may have abnormal tests (e.g. a bulging disk or herniation) with no pain complaints or substantial pain with minimal or negative testing results.
This is because chronic pain can develop in the absence of any skeletal changes that we are able to detect with current technology. Excessive muscle tension, strain and inflammation are common causes of chronic pain, yet may be extremely difficult to detect unless a clinician is familiar with biofeedback (EMG, EEG, temperature, EDR, etc.) technology.
Despite the proven effectiveness of biofeedback as a therapy, the vast majority of clinicians are not trained to use biofeedback equipment for evaluation and treatment and do not have access to the necessary equipment.