APA Book Notes
Health-care professionals are beginning to recognize that often the best way to manage chronic pain in their patients is to understand their patients' personality characteristics. This link between personality and pain is explored in a new 272-page volume published by APA Books, "Personality Characteristics of Patients with Pain," edited by psychologists Robert J. Gatchel, PhD, and James N. Weisberg, PhD.
Some 70 million Americans will experience acute, recurrent or chronic pain this year, and for many of them surgical and pharmacological interventions will fail to relieve suffering. What enables some patients to cope better than others with pain? Although research shows no single pain-prone personality, according to this book, patients vary widely in how they perceive and adapt to pain.
"Up until now, there hasn't been one text that summarizes the different types of personality characteristics or explains how to evaluate patients with pain and then use that information in a pain-treatment program," says Gatchel, the Elizabeth H. Penn distinguished professor of clinical psychology at the University of Texas Southwestern Medical Center at Dallas.
The book provides some of the first work on how perceived optimism and control over one's environment may boost a patient's ability to cope with chronic pain. It also delineates the best methods for assessing personality and coping characteristics with such instruments as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Beck Depression Inventory and the Multidimensional Pain Inventory.
According to the editors, no single measure of personality can capture the important characteristics of all patients with pain. Rather, each patient is unique and health-care professionals may need to administer an array of tests to best understand that patient's personality characteristics.
Health-care providers also need to investigate the patient's past history concerning social relationships, support networks, life/job satisfaction and success and history of coping with stressors.
"Treatment staff need to consider each patient's individual personality, the strengths of their personality and capitalize on them in the treatment plan," says Weisberg, a professor in the department of psychiatry and behavioral sciences at the State University of New York at Stony Brook.
A patient with longstanding depression, for example, may feel helplessly resigned rather than take any active role in therapy. A patient with borderline personality disorder may respond to the added stress of chronic pain by making inordinate demands on health-care staff, requesting unnecessary medication and becoming angry and threatening if demands aren't met.
Highlights from the book include:
- A recommendation that the MMPI-2 should be only part of any comprehensive evaluation of patients with chronic pain. MMPI-2 results provide information about patient's individual characteristics that often correlate with other important pain variables, such as pain behaviors, levels of emotional distress, difficulty performing daily activities and patterns of medication use. For instance, patients with neurotic personalities may be hypersensitive to minor pain and discomfort, says Gatchel, because their anxiety lowers their threshold for pain.
This type of information can help treatment teams establish realistic patient treatment goals.
- A recognition that psychological interventions seldom cure pain but interventions such as realistic thinking, relaxation and imagery can help people cope with pain.
- A step-by-step explanation of how practitioners should evaluate personality to manage patients with chronic pain.
- An assertion by Weisberg that the application of diathesis-stress model might explain the high prevalence of diagnosed personality disorders in chronic-pain patients. Basically, the model states that an individual's underlying genetic and/or psychosocial vulnerabilities may or may not become expressed as a function of the stress level the patient experiences. For instance, a patient may have pre-morbid personality traits that are marginally adaptive and, under the stress of pain and subsequent difficulties, those personality traits are magnified to the point that a personality disorder becomes diagnosable.