This issue is about understanding musculoskeletal pain.
In my qualifications, I mostly deal with musculoskeletal problems, but sometimes I don't because of differences in my qualifications.
In understanding musculoskeletal pain, what are some of the things you shouldn't do? Let's study together some research that has some tips on what not to do.
Behavioral responses that should not be done
There is a concept called the "fear-avoidance model" that is used to explain the relationship between thoughts about pain and related disorders.
One reason why this approach is not recommended is that avoiding fear due to pain can lead to sparse behavior.
This model is based on the idea that when we recognize and believe that musculoskeletal pain poses a threat to our health and well-being, a fear response is triggered, which can lead to fear-avoidance "behavior.
For example, a person with back pain may restrict a lot of muscle activity to avoid pain, which may manifest as "protective" reactions such as exercise restriction and muscular defenses.This can affect activities of daily living, avoidance of pain-related activities, and fearful avoidance of activities can lead to an unintended dependence on others.
However, fear-avoidance behavior can be seen as a common sense problem-solving response to a health threat, and it is logical to avoid and protect pain from body parts.
While logical, there is evidence that these behavioral responses perpetuate pain and disability, and supporting and protecting others may itself increase tissue load.
This may increase nociception, heighten the experience of pain, and promote a pernicious fear-avoidance cycle.
Therefore, it is not advisable to use the "fear-avoidance model" for clinical guidance or treatment strategies.In general, think of a person who has a painful back and is instructed to limit his or her activities so as not to cause pain.
Emotional reactions that should not be done
Eliciting negative emotional reactions represents a response to ineffective coping strategies for managing pain, which can lead to loss of engagement in valuable activities and threaten work, social life, and physical health.
Avoidance of work activities affects job security and future financial aspects, and causes emotional distress, which further serves to heighten the experience of pain.
Other negative emotions such as frustration, anger, and guilt over not being able to engage in worthwhile life activities due to them can lead to changes in the "sense of self" that exacerbate the pain-related distress.
The inability of health care providers to understand a person's pain can also lead to negative emotional reactions.
In medicine, pain must be attributed to a disease, but the problem arises when the disease cannot be identified.If the medical condition cannot be explained, then the symptoms must be considered psychogenic.
Patients diagnosed with non-specific musculoskeletal pain may feel that the validity of the pain they are feeling is being questioned.
This is reinforced by studies that show that health care professionals blame patients for not being able to explain their symptoms, and perceive pain to be "in their head.
Patients may seek biomedical explanations that go into the diagnosis-treatment-therapy pathway to justify the symptoms that are occurring, and may demand more care.
They are also more likely to receive conflicting information, which can lead to increased diagnostic uncertainty and experience unwanted pain.
These emotional reactions are reinforced by the fear avoidance mentioned in the previous section.
Common practices of medical professionals that should not be done
Studies have shown that clinicians have false and unhelpful beliefs about musculoskeletal pain.
In clinical settings, clinicians provide care under time constraints, and their advice may have unintended consequences due to their reliance on biases in clinical profiles and treatment advice.
Therefore, healthcare professionals should ask themselves the following questions
What beliefs do I have about the body and musculoskeletal pain?
What is the basis for these beliefs?
Do I have any experience with musculoskeletal pain?
What has been my reaction to dealing with musculoskeletal pain?
What was my emotional response to musculoskeletal pain?
Am I aware of my own clinical biases?
How do I respond to a patient's emotional distress or conflicting beliefs?
Even specialists can cause unexpected negative emotions in their patients due to their own common sense.
Caneiro JP, Bunzli S, O'Sullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Braz J Phys Ther. 2021;25(1): 17-29. doi:10.1016/j.bjpt.2020.06.003
Conclusion
As a medical professional, it is my job to treat the patient's "symptoms," but sometimes the patient wants the "pain" to be solved rather than the symptoms to be solved.
How they feel about it is something that only they can know, but it is true that the results of studies such as the text above have caused misunderstandings among health care professionals.
