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Target ‘mental defeat’ to treat chronic pain

U. WARWICK (UK) — Healthcare workers should be on the alert for signs of mental defeat in chronic pain patients as it can increase risks of depression and anxiety, research shows.

The concept of mental defeat has previously been associated with post-traumatic stress disorder, but this study applies it to the experience of chronic pain.

Mental defeat occurs when pain patients view their pain as an “enemy” that takes over their life and removes their autonomy and identity.

The study, published in the Clinical Journal of Pain, analyzed three groups of individuals living in Hong Kong—people with chronic pain who had sought specialist treatment, people with chronic pain who did not require specialist treatment, and people with acute pain.

The chronic pain individuals reported pain in a variety of sites, with the majority in both groups identifying back pain as their predominant complaint.

The researchers monitored levels of mental defeat through how much the participants agreed with statements such as “because of the pain I felt destroyed as a person” and “I felt humiliated and that I was losing my sense of inner dignity.”

When the two groups of individuals with chronic pain were compared, those who were seeking specialist treatment for their pain were found to have higher levels of mental defeat than those who did not require such treatment.

Both chronic pain groups had higher levels of mental defeat than the acute pain group.

The study also found that people who had a sense of mental defeat because of pain also reported higher levels of depression and anxiety as well as a higher incidence of the pain interfering with their daily lives.

Cross-cultural phenomenon

The findings of the Hong Kong study reflect earlier studies carried out in the United Kingdom, which suggests that mental defeat is common across cultures.

“The presence of mental defeat in both Western and Eastern populations suggests that aspects of the psychological impact of pain on people’s sense of self and identity are shared across geographical boundaries,” says Nicole Tang of the department of psychology at the University of Warwick, the study’s lead author.

“We know from work in the UK that mental defeat is a significant factor differentiating chronic patients who thrive despite pain from those who develop high levels of distress, depression, and interference from pain in their every-day lives.

“These findings suggest that early screening for mental defeat can predict whether a patient will go on to suffer from severe anxiety and depression. Standard group pain management programs do not have a treatment component targeting the sense of mental defeat.”

“The current development of multidisciplinary pain management services in Hong Kong presents an opportunity to address this gap with a view towards enhancing overall treatment effectiveness.”

Source: University of Warwick