Intended for healthcare professionals

Rapid response to:

Editorials

Emotional wellbeing and its relation to health

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7173.1608 (Published 12 December 1998) Cite this as: BMJ 1998;317:1608

Rapid Response:

Holistic care is vital and takes time

I was pleased to read the editorial by Sarah Stewart-Brown on
emotional wellbeing and relation to health. It has been known for a long
time that many patients with chronic benign pain also develop anxiety and
depression [1]. Many of these patients have not received a diagnosis to
explain their pain and abnormal beliefs about the meaning of the pain
contribute to the anxiety. Depression and anxiety both exacerbate
perceived pain severity and increasing pain worsens anxiety and depression
[2]. Chronic pain affects up to 14% of the population at any time [3].
The commodity that we as pain management clinicians have in greater
abundance than other doctors is time. First appointments in most clinics
receive atleast thirty minutes with review appointments receiving ten to
fifteen. This time is of vital importance not just for taking of history
and examination (these in themselves can be therapeutic) but time taken
for explanation of symptoms and meaning of pain is one of the most
important.
Good explanation reduces anxiety which in itself reduces symptoms. This
has been well demonstrated in pain management programmes where much time
is taken over explanation and ensuring correct understanding of the
meaning of benign chronic pain. These programmes reduce not only
disability and anxiety/depression but also pain [4].
Modern medicine has conquered many diseases and halted others but it is a
fact that greater than 80% of symptoms with which patients consult general
practitioners remain undiagnosed [5]. The skill of being a good doctor
therefore will often have as much to do with powers of explanation and
reassurance then with powers of diagnosis. The holistic
(emotional,physical and social) understanding of the patient is essential
in promoting recovery. Adequate time spent in acquisition of this
knowledge may save the patient from much emotional and physical illness at
a later date.

References:

[1] Bonica JJ 1979 Important clinical aspects of acute and chronic pain.
In: Beers RE, Bassett EC(eds)Mechanisms of pain and analgesic compounds.
Raven Press, New York, p 183.

[2]Craig KD 1989 Emotional aspects of pain. In: Wall PD, Melzack R(eds)
Textbook of Pain. Churchill Livingstone p 220

[3]Taylor H, Curran MM. The Nuprin Pain Report. New York: Louis Harris,
1985.

[4] Williams AC, Nicholas MK, Richardson PH et al. Evaluation of a
cognitive behavioural programme for rehabilitating patients with chronic
pain. British Journal of General Practice 1993; 43:513-518.

[5]Kroenke K. Symptoms in medical patients: an untended field. American
Journal of Medicine 1992; 92(suppl 1A): 3S-6S.

Competing interests: No competing interests

14 December 1998
Colin McCartney
Specialist Registrar in Anaesthesia
Aberdeen Royal Infirmary