The document discusses the complex relationship between meaning, perception, and chronic pain, emphasizing that patients' appraisals of pain significantly influence outcomes, particularly in surgical contexts. It highlights the role of psychological factors in the development of chronic pain and questions current medical practices regarding preoperative assessments and the integration of psychological support in surgical decisions. The conclusion asserts that understanding the meaning of pain is essential in addressing chronic pain effectively.

1. 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

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

3. 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

4. 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

5. 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?

6. 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

7. 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”?

8. 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

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