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

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

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

Patients actively appraise…

Pain

Other physical symptomology

What is said to them

What they think they should do

Meaning in chronic pain 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

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

Meaning in chronic pain 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

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

Meaning in chronic pain 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?

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?

Meaning in chronic 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

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

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”?

Meaning in chronic pain 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

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?

Are we are doing enough to identify appropriate surgical patients via psychosocial screening?

How can we prepare patients adequately for

successful surgical outcome?