Chronic pain was originally defined as pain that has lasted 6 months or longer. It is now defined as pain that persists longer than the normal course of time associated with a particular type of injury. This constant or intermittent pain has often outlived its purpose, as it does not help the body to prevent injury.

Causes

Chronic pain is essentially caused by the bombardment of the central nervous system (CNS) with nociceptive impulses, which causes changes in the neural response. The pain subsequently provokes changes in the behavior of the patient, and the development of fear-avoidance strategies. As a result, the patient may also become physically atrophied and deconditioned. However, it is important to remember that chronic pain is multifactorial, with the underlying biological changes affecting physical and psychosocial factors.

Pain is usually elicited by the activation of specific nociceptors ('nociceptive pain'). However, it may also result from injury to sensory fibres, or from damage to the CNS itself ('neuropathic pain'). Although acute and subchronic, nociceptive pain fulfils a warning role, chronic and/or severe nociceptive and neuropathic pain is maladaptive.

Types

It  discusses chronic pain in two categories: malignant and non-malignant.

• Pain associated with malignancy can be caused by the cancer itself or by treatment.
• Non-malignant pain includes a variety of causes: arthritis, neuropathy/neuralgia, back pain from injury or disorders (cervical stenosis, degenerative disc disease, other disc disorders, etc), migraines and other types of headaches, abdominal pain from chronic pancreatitis, bowel disorders, etc; pelvic pain from various conditions (endometriosis, interstitial cystitis, etc); and also diffuse conditions such as fibromyalgia, reflex sympathetic dystrophy, lupus and other systemic autoimmune/connective tissue conditions, multiple sclerosis and some other neuromuscular conditions.

Chronic pain can occur anywhere in the body; this list includes only a few examples of conditions that can cause chronic pain.

The most common symptoms are a tingling sensation near or around the area where the operation was performed, sharp shooting pains, severe aches after much movement, constant 'low ache' all day and sometimes a general 'weak' feeling.

Contrary to popular belief, all pain is real. This may seem like an obvious statement, but people with chronic pain are sometimes treated as if their chronic pain is either imaginary or exaggerated. In some cases, they feel like they have to prove their chronic pain to their friends, family and doctors. Some patients are told by their doctor that there is no reason for the chronic pain and therefore “it cannot be that bad”.

Chronic pain  is a personal experience and cannot be measured like other problems in medicine, such as a broken leg or an infection. For instance, a broken leg can be confirmed by an X-ray and an infection by a blood test measuring white blood cell count. Unfortunately, there is no medical test to measure chronic pain levels.

To make matters more challenging for the patient, for many chronic pain problems there is no objective evidence or physical findings to explain the pain. Thus, many chronic pain sufferers go from one doctor to the next searching for explanations. This process can lead to unnecessary evaluations and treatments, in addition to putting the patient at risk for actually being harmed or made worse by the healthcare profession.

Everyone experiences and expresses pain differently. Two people with the exact same injury will feel and show their pain in unique ways depending on a number of things such as:

• The situation in which the pain occurs
• Thoughts about the chronic pain, such as “this is nothing serious” versus “this pain could kill me”
• Emotions associated with the chronic pain, such as depression and anxiety versus hopefulness and optimism
• Cultural influences determining whether a person is to be more stoic or more dramatic in showing pain to others

The newest theories of chronic pain can now explain, on a physiological level, how and why people experience pain differently.

( Azad and Zieglagansberger, 2003)

 

 

 

Dr Smita Pandey Bhat, Clinical Psychologist 

 

http://child-psychologist.blogspot.com

Autism is a kind of problem where the children could not interact properly with others, where they have problems in social interactions and problems in communications where they are not able to able to express themselves properly and they have a repetitive behavior where they repeat the activities again and again.

The repetitive activity might be a stereotyped behavior like making same kind of sounds repetitively or body rocking, or compulsive activity like following strictly certain rules such as arranging objects in a line , sameness in behavior, they are resistant to change or following a kind of ritual or restricted behavior such as preoccupation with television program, toy or a game and sometimes self injurious behavior such as hand biting , skin picking or head banging.

Though, they find it difficult to interact socially, still they believe in quality of friendship rather than the number of friends. They feel lonely sometimes and would like to interact with others but since they do not understand that why the other person is smiling at him and even if they are able to understand it they find it difficult to communicate with them as they found it difficult to find words and express themselves.

Sometimes they also have speech defects or deficits and they are not able to communicate due to this. For the treatment basically the speech therapy and behavior therapy and occupational therapy is recommended besides psychoactive drugs as prescribed by the clinical practioner.

Dr Smita Pandey Bhat
Clinical Psychologist
Gurgaon, Delhi - NCR, INDIA
Email : dr.smitapandey@gmail.com
Url : http://child-psychologist.blogspot.com

Few days back a person came to me with the complaints that he is not able to concentrate on his work anymore. He had sleepless nights and that he lost pleasure in most of the things he used to like. Also, he used to feel sad, gloomy and irritable all the time. He felt that his life is not worth living and that he should die. All the time he felt tired and low in energy. What is this person suffering from?

The answer is depression.

The people in depression feel sad, tired and low in energy all the time. They are usually not able to concentrate on their work. Either they sleep very less, wake up early in the morning or they sleep too much and feel like not getting up in the morning. The time becomes hard for them to pass as they feel very gloomy and sad. They lose pleasure in their surroundings and feel that it is very difficult for them to stand the day.

Since the arrival of the day is very painful to them they feel very difficult to get up in the morning. Even if they are not feeling sleepy they lie in the bed as the arrival of another day is not welcoming anything new to them. They feel low in energy all the time and not able to enjoy their day to day usual activities. Sometimes they feel like crying and they actually cry a lot. Most of the time they feel that they are no good, they cannot do anything well and that they are worthless.

They cut themselves of from the social circle because they have lot of shame and guilt about themselves not performing well. They feel helpless because of moving away from the society. They feel hopeless as all the things appear to them as gloomy and that they feel that the life has come to an end and that there is no hope in their life. Sometimes they think of committing suicide as well because they feel hopelessness in their lives. Sometimes they plan to take suicidal actions. Mostly people do not act on these plans but sometimes they actually does act over these plans.

So you need to be very careful if someone related to you is suffering from these problems. The treatment for depression is the medications and psychotherapies. The medications involve several antidepressants which try to ward off depression. The idea behind medications is that prolonged stress can make neuro chemical changes in the brain which might cause some changes in emotions and behavior.

The response to stress is a fight or flight reaction. Either you try to maintain your behavior through fighting it off or you try to avoid these situations or run away from the situation. For example if a snake comes through your way you will be frightened and you will undergo a lot of emotional changes resulting in the fighting behavior (to kill the snake) or the flight behavior (running away from the place). You experience these emotions due to changes in the chemicals in your brain.

But these emotions become permanent if the stress is prolonged as these chemicals cause derangements in your brain. Taking medications from outside would try to maintain your equilibrium. The medications would try to release either those chemicals in your brain which release those neurotransmitters that are healthy for you or try to block those neurotransmitters that are unhealthy for you. Psychotherapies like cognitive behavior therapy focus on the thinking style (cognitions).

It believes in the concept that the thinking style affects your emotions and behavior. If you start thinking positive then your emotions and behavior will be positive and if you think negative then your behavior and emotions will be negative and you will feel sad and gloomy all the time. So it is all about your perceptions - how you perceive the world.

For example do you feel the glass is half "empty" or half "filled". The therapist try to validate your thoughts from the reality, he/she try to focus on the evidences that what evidences are there which makes your assumptions and automatic thoughts. Then therapist gives you lots of homework’s and a schedule of activities to keep yourself busy all the time so that you do not find it difficult to kill time and that you are engaged constructively which can bring back your zeal and enthusiasm towards life. Therapist acts as a support towards all the activities you do and he/she tries to encourage the person who is depressed.

One thing I would like to add here is that the antidepressants and the Cognitive Behavior therapies might be used separately but when they are used in combination, the results and benefits are more effective. Please find out if anybody related to you is suffering from these symptoms and try to help him or her. You may contact your nearest clinical psychologist and psychiatrist for the advice.

Dr. Smita Pandey Bhat
Clinical Psychologist Delhi
Email : dr.smitapandey@gmail.com
Url : http://child-psychologist.blogspot.com 

Your child may be suffering from ADHD and you might not even know it! ADHD affects about 4 to 12% of school-age children in India and is more frequent in boys than in girls. Global prevalence for children is approximately 5%, with wide variability dependent on research methodologies utilized in studies. If the short attention span of your child poses problems for him, at school or home, and his hyperactivity is a cause of concern, chances are that he might be a victim of this neurobehavioral developmental disorder and needs serious medical attention. Don’t pass-off your child’s behavior as just ‘difficult’. Learn to detect and eliminate the symptoms and stop the disease before it strikes!

Attention parents and teachers! Learn to deal with inattentive, hyperactive & impulsive kids

Attention deficit hyperactivity disorder (AD/HD or ADHD) is a disorder of the brain and behavior. The symptoms start before seven years of age. ADHD is one of the most common mental disorders that develop in children. Children with ADHD have impaired functioning in multiple settings, including home, school, and in relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood.

Symptoms: The most common symptoms of ADHD are:

1. Impulsiveness: acting before thinking of consequences, jumping from one activity to another, disorganization, tendency to interrupt other peoples' conversations.
2. Hyperactivity: restlessness, often characterized by an inability to sit still, fidgeting, squirminess, climbing on things, restless sleep.Inattention: easily distracted, day-dreaming, not finishing work, difficulty listening.

Subtypes: ADHD has three subtypes:

1. Predominantly hyperactive-impulsive: Most symptoms (six or more) are in the hyperactivity-impulsivity categories.Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.
2. Predominantly inattentive: The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.
3. Combined hyperactive-impulsive and inattentive: Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.Most children have the combined type of ADHD

Causes: A specific cause of ADHD is not known. There are, however, a number of factors that may contribute to ADHD including genetics, diet and social and physical environments.

1. Genetic factors: Studies indicate that the disorder is highly heritable and that genetics are a factor in about 75% of ADHD cases. Hyperactivity also seems to be primarily a genetic condition however other causes do have an effect.Researchers believe that a large majority of ADHD cases arise from a combination of various genes, many of which affect dopamine ( a chemical in the brain) transporters. The broad selection of targets indicates that ADHD does not follow the traditional model of a "genetic disease" and should therefore be viewed as a complex interaction among genetic and environmental factors.
   
2. Environmental factors: Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and environmental exposure to lead in very early life. Complications during pregnancy and birth—including - premature birth—might also play a role.
   
3. Diet:
   • Additives: Studies have found that dietary elimination of artificial food coloring and preservatives provides a statistically significant benefit in children with ADHD
   • Sugar regulation: A number of studies have found that sucrose (sugar) has no effect on behavior and in particular it does not exacerbate the symptoms of children diagnosed with ADHD
   • Omega-3 supplement: Preliminary research suggests that Omega-3 supplementation might be effective in the treatment of ADHD; however some of the studies give conflicting results.
     
4. Social factors: There is no compelling evidence that social factors alone can cause ADHD.[ Many researchers believe that relationships with caregivers have a profound effect on attentional and self-regulatory abilities. A study of foster children found that a high number of them had symptoms closely resembling ADHD, while other researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse.
   
5. Head injury ADHD patients have been observed to have higher than average rates of head injuries, however current evidence does not indicate that head injuries are the cause of ADHD in the patients observed
   
6. Pathophysiology: One study states that a delay in development of certain brain structures like frontal cortex and temporal lobe occurs by an average of three years of age. These structures are responsible for the ability to control and focus thinking. On the other hand the motor cortex develops faster than normal. It indicates the slower development of behavioral control and faster development for advanced motor development may cause increased attention deficits and hyperactivity.
   
   Another study states that there is unusual thinness of the cortex of the right side of the brain, accounting for about 30% of genetic risk for ADHD. Also it has been seen that this region normalizes in thickness during the teen years showing improvement in clinical symptoms Additionally, SPECT scans found people with ADHD to have reduced blood circulation (indicating low neural activity), and a significantly higher concentration of dopamine transporters in the striatum which is in charge of planning ahead.
   
   Medications focused on treating ADHD (such as methylphenidate) work by reducing dopamine reuptake in certain areas of the brain, such as those that control and regulate concentration. As dopamine is a stimulant, this increases neural activity and thus blood flow in these areas (blood flow is a marker for neural activity).

Treatment: Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it. Methods of treatment usually involve some combination of medications, behavior modifications, life-style changes, and counseling.

Lifestyle: Aerobic fitness may improve cognitive functioning and neural organization related to executive control during pre-adolescent development, though more studies are needed in this area. One study suggests that athletic performance in boys with ADHD may increase peer acceptance when accompanied by fewer negative behaviors

Medications: The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants.

For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child.

Any child taking medications must be monitored closely and carefully by caregivers and doctors. Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body.

Long-acting or extended release forms often allow a child to take the medication just once a day before school, so they don't have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.

The side effects of stimulant medications: The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.

• Decreased  appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child's doctor. Also talk to the doctor if you have concerns about your child's growth or weight gain while he or she is taking this medication.
• Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of an antidepressant or a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
• Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing "flat" or without emotion.

Psychotherapy: Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior.

Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training. Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child's behavior.

Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of "time-outs" may be used when the child's behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.

Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child's strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become over stimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps.

Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child's behavior. Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes.

Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

 

Dr Smita Pandey Bhat is a Counselor and Clinical Psychologist. She has completed her M.Phil and PhD in Clinical Psychology, from Central Institute of Psychiatry (C.I.P), Ranchi. She has seven years of experience in this field at different places. She provides psychological counseling, psychotherapies like, Supportive Therapy, Cognitive Behavior Therapy, Interpersonal Therapy, Social Skills Training, Assertiveness Training etc. as per the requirement of the people. She also provides assessments like Intelligence Tests and Personality Assessments for Children as well as Adults.

Dr. Smita Pandey Bhat
Clinical Psychologist
Gurgaon, Delhi

Email  :   dr.smitapandey@gmail.com
Url      :   http://psychologist.rediffblogs.com