Content area
Full Text
PAIN AND THE DIFFICULT PATIENT
While the author has treated numerous kinds of problems with hypnosis, the focus of the remaining part of the paper will be on the use of technique with "problem patients," and the patient with pain in a general hospital setting. A brief discussion of the phenomenon of pain and a definition of the problem patient will be the first focus of this section, followed by discussion of how to choose a client, and then the principles of beginning treatment with that client.
Pain and the difficult patient often occur simultaneously. The problem patient often is identified as difficult by the staff because in some way he/she fails to meet expectations for "appropriate behavior." Since behavior, problematic or not, has meaning and is goal directed, an exploratory approach can be the first step toward clearly identifying and subsequently solving the problem. The psychophysiological reactions to trauma, stress, and illness precipitate a variety of behavioral responses. When an individual's adaptive skills are not successful, then more attention getting behavior is often the result, For example, the patient who has pain requests help, but must wait beyond the time when pain medication should be given; he/she may become demanding, hostile, and even abusive. Another individual with a similar situation may withdraw and become severely depressed and exhausted from the psychological stress and the physiological stress of experiencing intense pain.
Burned patients frequently become problem patients. They first have a disfiguring, life-threatening trauma, and second they experience both consistent and acute episodes of pain. Often the pain is induced by the staff who are trying to save the individual from infection by frequent dressing changes and debridement of burned tissue. The world for many of these patients begins to look hostile, hurtful, and frightening. Many feel they have little or no control over what they have to experience. As a result, they become hostile and demanding - begging, in an angry way, just to be left alone. Others become depressed and threaten to give up and die rather than deal with the pain and the psychological trauma of disfigurement.
PAIN
Pain is a phenomenon that has great individual variability. Some individuals report experiencing more pain than others for a similar surgical procedure; some react...