According to Beth Darnall, PhD, a Stanford pain psychologist, the “experience” of pain is both a sensory and emotional experience. There is the physiological component that is responsible for the mechanical/physical aspects of pain, and the psychological component, where the pain is interpreted and realized. Addressing both components, therefore, is a prudent approach to treating pain.
A recent systematic review of 21 studies published in May 2014 in The Spine Journal showed that patients with the highest risks for “fear-avoidance” beliefs are those with sub-acute low back pain for four weeks to three months.
Dr. Maria Wertli, M.D., from the University of Zürich found that among four cohort studies, patients who had fear avoidance beliefs were less likely to return to work. Earlier interventions to reduce this fear may help patients recover faster and avoid chronic pain to set in.
The “fear avoidance” model, which is still under debate among researchers, suggests that people who are extremely fearful are prone to avoid movements and activities that they feel may trigger pain. According to physiotherapist Lorimer Moseley, professor of clinical neurosciences at the University of South Australia, this leads to “disengagement from meaningful activities, disability, and depression,” The fear-avoidance mindset basically starts a vicious cycle which takes root in the mind to the point where the fear of pain has a larger impact on behavior than pain itself.
However, fear-avoidance behavior is understandably difficult to detect among chronic low back pain patients, which can cause practitioners to either ignore psychological factors that could influence pain or wrongly associate the behavior in the diagnosis/ identification of the actual area of damage.
Moseley mentioned fear may not be readily seen in patients because they seldom display cardinal signs of fear unless they are confronted directly with movement that may be perceived to cause pain. For example, if patients are asked to bend forward to touch their feet, they may exhibit fear to do so because they think the movement would cause pain. The fear-avoidance behavior model is also too simplistic to explain most cases of chronic low back pain, and it is rarely the sole reason patients avoid “painful” movements.
It’s been said that the human brain is more mysterious than the entire universe. While science has still much to learn about how the mind can cause pain, health professionals should still consider fear-avoidance belief as a factor in patients with chronic low back pain. It can have powerful effects on their cognitive processes, which can increase the “experience” or intensity of their pain, and/or prevent them from engaging in exercises that could otherwise improve their condition.
This study affirms that certain mind-body approaches such as guided visualization, meditation, yoga and similar holistic techniques can be an effective adjunct to treating chronic pain.
Here is a video of Dr. Darnall explaining the relationship between chronic pain and psychological state:
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Reference: Guardian Liberty Voice