Biopsychosocial Assessment

• Developing understandings of Chronic Pain:

  • chronic primary pain is defined as pain in one or more anatomical regions that:
  • persists or recurs for longer than 3 months
  • is associated with significant emotional distress (e.g. anxiety, anger, frustration or depressed mood) and/or significant functional disability (interference in activities of daily life and participation in social roles)
  • and the symptoms are not better accounted for by another diagnosis
• Summary of Chronic Pain:

  • affects a large percentage of the population and may increase risk of poor health
  • has significant individual costs such as limitation on function and the subsequent impact of this on life and relationships and ability to generate income
  • population level costs associated with work absence, health and social care
  • affects the population in a way which highlights health inequity linked with social and economic factors
• Clinical Presentation of Chronic Pain:

  • History and Mechanism of Injury:
  • pain for several months or episodic pain
  • mechanism is variable or insidious onset
  • can be related to other conditions e.g. multiple sclerosis
  • Subjective features:
  • pain - often diffuse in nature and can be widespread
  • pain limiting function
  • distress is common
  • Objective features:
  • variable
  • Key impairments:
  • often limitation of movement in effort to reduce or eliminate pain
• Questions for Chronic Pain:

  • how does the pt understand their condition?
  • what does the pt see as the solution?
  • is what theyre doing moving them toward or away from the life they want?
  • how can I help the pt understand their condition?
  • how can I support the pt to make changes to what they do, which may serve them better?
• Exploring the impact of pain for the patient

  • what is your pain getting in the way of you doing?
  • with family, friends, your partner, at work?
  • are there any activities that you have stopped doing or would avoid due to your pain?
  • when your pain is bad, what do you tend to do?
  • how are you doing, as a person?
  • if our work together was to make a difference, what would I see you doing differently from now?
• Chronic Pain & Daily Rhythms:

  • does pain affect:
  • sleep
  • appetite
  • routine
  • personal care
  • caring roles
  • work/education
  • exercise
• Chronic Pain & Work Factors:

  • work related factors can be split into 2 categories:
  • blue flags
  • black flags - systemic factors
  • pts perception of their workplace can include beliefs on how theyre seen, what people think of them if they take sick leave and their perception of their security in their job
  • systemic factors include contractual obligations, amount of sick leave one can take, work environment, how much force the work have over their employees
  • work factors:
  • litigation
  • compensation
  • systemic factors
  • pay
  • conditions
  • life role (bread winner)
• Clinical guidelines:

  • produce guidelines that cove chronic pain management
  • highlight how important exercise is and that manual therapy and psychological approaches shouldnt be done in isolation
  • skillset needs to be developed for assessment of chronic pain and its management
• Explaining pain to patients:

  • need to provide reassurance
  • explain the pain and its impact
  • provide validation
  • communication strategies:
  • talkback
  • chunk and check