Issues of acceptance in chronic pain populations.

Chronic pain, defined as recur- rent pain which last for longer than six months, represents a wide spread and challenging problem affecting as many as 75 million Americans and which has considerable impact on the quality of life for the people who are experiencing it (Borrica, 1987; Frymoyer & Cats-Baril, 1991). For many of these individuals no clear diagnosable etiology for their pain will be identified (Deyo, 1986; Dworkin & Massoth, 1994) and, despite substantial expenditures, in many, if not most cases, chronic pain continues to be poorly managed within traditional medical settings (Crook, Weir & Turks, 1989). To improve treatment outcome and broaden our understanding of this complex behavior, a number of theorists have expended the conceptualization of pain to include psychological factors and indeed the official definition of pain acknowledges the presence and role of psychological factors in the experience of pain (Flor & Turk, 1984; Fordyce, 1976; Gatchel & Turk, 1996). Within the now broadly recognized biosocial model, pain is defined as a physical, emotional, and behavioral experience associated with actual or potential tissue damage (Gatchel & Turk, 1996; Melzack & Walls, 1982). There are several important implications which follow from this definition. The foremost of which is that all pain in humans is mediated by psychological factors. Amongst other things, this means there is no such phenomena in humans as "true pain" and searching for distinctions between Psychogenic vs. Organic pain is not useful. However, there is a large variation in the type psychological factors present, the extent to which they are influencing perception and expression of pain, and the impact they are having on treatment. By including behavioral and cognitive-behavioral treatments in pain management programs, treatment outcomes improve considerably and there is a substantial body of literature demonstrating the efficacy of multidisciplinary approaches to chronic pain management (Flor & Turk, 1984; Fordyce, 1976; Gatchel & Turk, 1996; Kerns, 1994). However, a sizable proportion of patients do not respond well even to structured multidisciplinary treatment programs (Turk, 1990; Turk & Rudy, 1991). It has been suggested that patient factors may account in part for differences in outcome (Keens, et al., 1997). One important factor that has not received extensive attention, but which may differentiate between responders and nonresponders, is acceptance of pain. In particular, acceptance of pain as a chronic condition which is going to require a different approach than that used for acute pain. As such, changing patient's level of acceptance can be an important part to effectively impacting their pain experience. Recently, within the field of clinical behavior analysis, there has been growing interest in the role of verbal behavior in the etiology and maintenance of psychopathology. As such, a number of individuals have written about the impact of "acceptance" on a variety of clinical phenomenon (Hayes, et al., 1994). This paper examines the possible role of acceptance vs. non-acceptance within chronic pain populations. Data from ongoing studies being performed at the University of Alabama at Birmingham School of Medicine suggest three general styles of responding to chronic pain. The first is what might be called the acute pain response. These individuals continue to be focused on seeking medical solutions to their pain. They are often in a great deal of emotional distress, are highly focused on identifying an etiology to their pain, often are seeking invasive solutions like surgery, engage in frequent "doctor shopping" seeking a total resolution and cure for their pain, see their pain as a medical problem which should be addressed solely by medical personnel, and put life goals on hold. Many Patients continue to seek treatment at high personal, as well as financial cost, which actually disrupts the chances of engaging ii a successful treatment (Amoff, 1991; Philips, 1987). …