Chronic Pain After Surgery Meaning

Meaning in chronic pain
Making sense is normal and adaptive
Chronic pain is not
Meaning of pain often negative
Meaning affects behaviour, mood
Meaning relevant to pre/post surgery

Patients actively appraise…
Pain
Other physical symptomology
What is said to them
What they think they should do

Appraisals relevant to pain include
Causal attributions
Self-efficacy
Meaning of increased pain
Implications of movement on pain
What the future holds
Locus of control
Family appraisals
Expectations of treatments
Beliefs about medication

Less obvious appraisals
What the pain means for function
What the pain means for personal identity
What are the implications for the family
What the pain means for work
What Hp’s say and how is this interpreted
What are the alternatives

Do patient beliefs affect outcome from surgery?
Findings inconsistent (Perkins & Kehlet 2000)
Pre-op anxiety associated with post op pain
Pain intensity predictive of chronic pain post-op.
(Ozalp et al 2003)
(Kain et al 2000)
Distress leads to chronicity via post-op pain?

Evidence strong for belief role in chronic pain development
Predictors of chronic low back pain
Distress
Fear avoidance
Particular beliefs
Work factors
Family overprotection
Iatrogenic factors
All involve perception and meaning

Meaning in chronic pain So…. Why do we still operate on those at risk from developing chronic pain? Why is “success” measured in terms of “ how the procedure went”? Why do surgical service developments not include psychological staffing? Why do psychologists still see those with “ failed back surgery syndrome”?

Conclusion
Pain and meaning are inseparable
To separate them is to misunderstand pain
Psychological factors are key to chronic pain dev.
Meaning relevant to pre and post surgery
Other services see meaning as important
SCS, cosmetic surgery, weight management

Are we are doing enough to identify appropriate surgical patients via psychosocial screening?
How can we prepare patients adequately for
successful surgical outcome?

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Chronic Pain After Surgery Meaning

by epicyclops on Nov 25, 2007

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