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PREFACE
This book
is an extension of my 1992 book entitled The Social Context of Chronic
Pain Sufferers. Many ideas nominally explored there are elaborated
in this volume, which is an attempt to fill a major gap in the chronic
pain literature. Although there has been a virtual flood of new works
on the medical and psychological aspects of chronic pain, such enthusiasm
is somewhat muted in relation to the social environment of the patient.
Although there is universal, recognition among pain experts that biological,
psychological, and social factors influence the experience of pain, the
social component (for reasons that are unclear) has failed to attract
much attention.
The need for a book focused on social relations
is obvious. The patient is not merely a carrier of symptoms. There is
a large social reality in the background of each patient; that reality
can have multidimensional consequences, from the way pain is perceived
to serious financial hardship and other sources of stress, complicating
treatment management, and, ultimately, the prognosis. Clinicians recognize
the value of incorporating the social dimension in the overall evaluation
and treatment of the patient. This book attempts to accomplish that task.
In order to achieve that objective, this
volume addresses many important elements in the patient's social environment-the
most significant being the family. Beyond the family, for a vast majority
of patients, work represents a major source of economic security and self-esteem.
Job loss, common in this population and a major cause of much personal
and family distress, needs critical examination. Similarly much of a patient's
energy involves dealing with formal organizations, such as the workers'
compensation board, insurance companies, etc. Many patients describe their
experiences with these organizations as humiliating and degrading, thus
adding to their already compromised sense of self. Interaction with the
medical world is perhaps the most important activity for the patient;
disappointment with health professionals is pervasive since many patients
do not find significant relief from their pain. Worse still, there is
much doubt about the cause of the pain. This book purports to bring to
the fore issues and problems that profoundly affect the sense of well-being
of our patients, and what actions are necessary meliorate or minimize
their sense of powerlessness.
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