Enfrentamento em pacientes com dor neuropática na perspectiva da psicanálise

Abstract

Neuropathic chronic pain caused by injury or disease in the somatosensory nervous system in the marrow or nerves, affects multiple dimensions, including the individuals’ quality of life. Objectives: To understand the context of neuropathic chronic pain; identify coping strategies; and analyze coping from a qualitative and quantitative perspective. Patients and Methods: This descriptive, cross-sectional study with a quantitative and qualitative approach was conducted in the Outpatient Pain Clinic of a School Health Clinic located in the northwest of São Paulo state, Brazil. Sixty-one patients with a medical diagnosis of neuropathic chronic pain participated in this study from August to December 2017. Data were collected using five instruments: semi-structured interviews (sociodemographic and clinical data); Pain DETECT (an intuitive and visual questionnaire addressing pain); Alexithymia Scale (measures difficulties to identify and describe feelings); Escala de Modos de Enfrentamento de Problemas (EMEP) [Ways of Coping with Problems Scale] and preliminary interviews (psychoanalytical perspective). All the interviews were recorded and transcribed. Discourse analysis was used and the categories were organized according to similarity. Results: The sociodemographic and clinical characterization of the 61 participants revealed that they were 50.67 years old (±13.12 years) on average; 57.38% were women; 59.02% attended primary school; 61.67% had a partner; the cause of pain for 39.34% was disease; 57.38% reported physical problems as the main changes they experienced after pain; and 68.85% presented a positive attitude towards pain. The mean score obtained in the pain detect was 22.72, that is, a positive result toward pain. No association was found between pain and gender (P=0.108); marital status (P=0.855); educational level (P=0.881); cause of pain (P=0.984); or changes after pain (P=0.420). Significant differences were found between pain scores and age (P=0.049) and with the way patients deal with pain (P=0.007). Religious practices, social support, and problem-focusing coping strategies obtained the highest scores in the EMEP. The results show that patients had difficulties expressing their emotions, feelings, and body sensations. Two categories emerged from the qualitative analysis of coping: religious practices and alexithymia. Conclusion: The quantitative results have showed that the coping strategies of patients with neuropathic chronic pain included religious practices, social support and problem-focusing strategies, with a statistically significant difference in regard to age and the way patients deal with pain. The results from the qualitative analysis enabled patients to gain awareness, from a psychoanalytical perspective, of the direct relationship between pain and mind. When we understand the relationship between pain and psyche, we verify a need to better prepare health workers for clinical practice. This study has showed that the psychoanalytic perspective is one way to cope with neuropathic chronic pain and improve the patients quality of life.