This is the first article in a short series covering topics from the Recover Forum held in Brisbane, 2016.
The way that people recovering from injury think, feel, and process their situation can spell success or disaster for rehabilitation. This is one thing I learned from attending the Recover Forum event in Brisbane in October.
The Recover Forum aimed to showcase the latest injury research and how researchers, policy makers, insurers and health professionals can work towards better rehabilitation for their clients.
In his keynote address, Professor Michael Sullivan, the Director of Recover, spoke about the debilitating effects that injury can have.
“Musculoskeletal pain conditions are the most expensive non-malignant health problems affecting the working age population,” he said.
Michael outlined a very succinct history of pain management in the medical and psychological fields. For many centuries, medical practitioners believed that pain was purely physiological but in recent decades a lot of work has been done to truly understand pain and how it affects people.
Now it is widely acknowledged that how you think and feel affects how much pain you’ll have. The mind has the power to take existing pain and make it worse or make it better. (Watch this video from the Agency for Clinical Innovation, New South Wales about the mental strain caused by chronic pain and how you can take action). And in case you were wondering, there is no evidence that the mind can create the sensation of pain.
The mind has the power to take existing pain and make it worse or make it better.
According to Michael, the medical profession should be paying much greater attention to the psychosocial factors that influence disability. These risk factors have been shown to amplify suffering, distress and disability. There are four key psychosocial factors that interact to influence outcomes:
- Catastrophising
- Fear
- Beliefs/expectancies
- Injustice
Catastrophic thinking
Catastrophising was defined by Michael as: “an exaggerated negative mental set brought to bear during actual or anticipated painful experience”. Catastrophic thinking has been shown to cause more severe symptoms, longer periods of disability after injury, reduced response to treatment of symptoms, higher likelihood of mental health problems.
Fear
According to Michael, fear is the primary driver for disability as people stop doing activities that cause pain because they are afraid they’ll cause more pain. This then leads to a downward spiral where people withdraw from physical therapy, become more sedentary, and statistics show a lower rate of return to work.
Beliefs/expectancies
Michael then went on to talk about how the power of belief influences rehabilitation.
“Beliefs are the roadmaps to human behaviour,” he said.
“The more you believe, the more you expect, the more your symptoms will respond to intervention.”
Ahh! So we say all together now: “1-2-3 placebo!!” Yes? (Read more about the placebo effect and how you can use it to your advantage. But note that some conditions are more easily influenced by placebo than others and these are: depression, pain, sleep disorders, irritable bowel syndrome (IBS), and menopause.)
When people believe something is not going to work, they lose motivation for rehabilitation and won’t do the things that health professionals advise. Evidence shows that longer periods of work disability result.
And medical professionals should also be more careful about what they say to patients. Saying things like: “this is likely as good as you’ll get” or “I don’t think you’ll ever get back to work” actually become the belief of the patient and can begin a downward spiral (a self-fulfilling prophecy perhaps).
Perceived injustice
Perceived injustice was an interesting topic to learn more about. If you’ve thought or said things like “it’s not fair” or “why did this happen to me”, then you could be thinking that you’ve been wronged.
Having these feelings can lead to longer periods of disability, more severe symptoms and mental health problems that last for longer than they otherwise would. It makes sense as well that people feeling they’ve been treated unjustly are more likely to go to court.
Are we on the road to change?
The call to action from the session was to encourage health practitioners to understand these psychosocial risk factors, to assess patients more effectively (using a range of tools like the pain catastrophizing scale) and to try new techniques when treatment isn’t working.
One of Michael’s closing remarks was “the drivers of symptoms are different to the drivers of disability”.
“The drivers of symptoms are different to the drivers of disability,” Michael Sullivan, 2016
That was a very intriguing point to me and emphasised again that while we may have symptoms of pain and other impacts from injury, the link between them and how we experience life is not pre-determined.
I’m excited to see ongoing research into the psychosocial risk factors that influence how someone recovers. I want to see this knowledge translated into practice and, most importantly, patient outcomes.
There are apparently a number of tools in circulation to assess how patients are doing (eg. Pain catastrophizing scale; Measure of pain-related fears; Self-efficacy assessments; Post-traumatic Stress Diagnostic Scale (PDS)). And I’ve spoken before about assessing your psychological distress and working towards resilience.
None of these tools were offered to me and no-one I have spoken to about their injuries has been asked about how they were faring as a result of their injury.
What will it take to have a holistic approach so that all in the injury recovery tribe have a better pathway out of injury?