Psychosocial Risk Profiles

Advances in pain neuroscience by Deepak Ravindran (the Painfree Mindset)

Adverse Childhood Experiences

95%

45%

1980 (ICIDH)

Disability = linear process:

1. Underlying cause

2. Impairment

3. Disability

4. Handicap

Past 20 years research:

Number of psycosocial factures contribute to severity of disability.

Some background

Definitions

Research shows that underlying medical symptoms do not necessarily have direct impact on disability.

Research on disability

4 Predictors of pronouned and prolonged

disability:

+Catastrophising

+Disability beliefs

+Fear

+Injustice beliefs.

Quebec:

Disability interaction of:

1. Personal

2. Environmnetal factors

3. Life habits

(Some physiological underlying factor cause)

Most effective rehabilitation programmes target these

Beliefs: mental construction not reality

Disability beliefs

Family background

Policies/ Insurance/ RAF

Disability

Beliefs

Beliefs concerning magnitude of limitations

Beliefs of self-efficacy

Health professionals

More severe symptoms

(40-60% more pain)

++inflammatory

Impact of catastrophic thinking

Less responsive to treatment

Eg. pain meds & surgery & coping stratergies

" Individuals with high levels of catastrophizing report more intense pain, more intense emotional detresss,, display more pain behaviours and are more disabled. "

Impact

- More pronounced disability!

- Abnormal central pain modulation

Susceptibility to mental health problems

• Deconditioning
• Substance overuse
• Failed treatments
• Mental health problems
• Iatrogenic problems
• Family dysfunction

Downward spiral

Facts, symptoms, life impact

Emotional Disclosure

Quality of relationship 30% effect

(Trust, confidence, genuineness, +orientation)

Thought monitoring and re-appraisal/ emotional problem solving

Variety techniques to produce meaningful long term reductions

What to do?

Education

Reassurance & Activity Encouragement

NB: check your mood!

Fear = prolonged work disability

Fear Avoidance Model of Pain and Disability

Components of fear:

- Escape

- Avoidance

Avoidance behaviours can become self-perpetuating.

Typically overestimate.

Fear = overestimate

Exposure = disconfirm

Grading NB!

Gradual Exposure

From low level anxiety to high.

What to do?

Pre-determined

Similar to treating phobias

Reduction in fear = reduction in pain-related disability = improved probability of RTW

activity

involvement.

Not tolerance intervention

Pain behaviour direct correlation with perceived injustice.

Pain behaviour also has a social and iatrogenic effect.

More severe symptoms

Persistence of mental health probs

Triggers anger experience/ expression

Males= anger

Females= depression

Longer periods of work disability

Propensity toward litigation

Impact of perceived injustice

Need to prove magnitude of suffering = pain behaviour

Reasons for injustice:

- Responsible for causing inj

- Disrespectful interactions

- Dismissive or minimizing comm

- Punitive responses

- Family members empathy 3 mths

1. Empathetic reflection

2. Identify role as helper

3. Relationship building disclosure

Solutions

NB Ally or Enemy!

• Validation (emotion not injustice)
• Anger management techniques (message received)
• Increase awareness of negative consequences of behaviour motivated by anger
• Examining factors fueling the client's perceptions of injustice

• Also same as catastrophising techniques

What to do?

Acceptance based Rx?/ Existencial/ narrative focussed