Fear and Pain
Pain is an undesirable consequence of musculoskeletal injury and is an experience unique to each individual. There are many factors that contribute to the pain experience. The noxious stimulation from injured tissues produces sensory aspects of the pain experience, and this seems to be the most obvious contributing factor. However, there are also cognitive, emotional and behavioral aspects of pain and a growing recognition that these factors play an important role in the way an individual interprets and responds to pain, and in how long pain persists.
One cognitive-behavioral aspect of pain that is getting a lot of attention in the scientific literature is the concept of fear-avoidance beliefs. Fear avoidance is the belief that musculoskeletal pain represents a threat to health. When faced with a pain event, the person that holds such beliefs will alter their behaviors and avoid activity. The problem with this approach to pain is that, with the exception of severe injury, movement and activity actually facilitate recovery. In fact, researchers have found a relationship between fear avoidance beliefs (FAB) and chronicity in musculoskeletal conditions; people with higher levels of FAB are more likely to develop chronic conditions and less likely to return to work after an injury.
Fear-avoidance beliefs can be measured with a self-report questionnaire. For example, a person’s level of agreement with a question such as “physical activity makes my pain worse” can determine the strength of such beliefs. When people with musculoskeletal pain have high levels of FAB’s, cognitive-behavioral interventions can be employed to address them. Many times, a simple educational intervention to help patients understand the importance of movement in recovery of function is enough.
As experts in movement function, physical therapists can help patients find positions of rest to protect injured tissues, while at the same time prescribe movements that will assist in the healing process. Physical therapists know that in most cases, focusing on function is the best medicine for pain.
Marcia Miller Spoto, PT, DC, OCS