Dr Graham explains that pain is, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” The brain is a pain output, according to Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy at the University of South Australia. Dr Graham explained that under Moseley’s theory, acute pain is generally accepted as being due to tissue damage, however even with acute pain, pain is output.

Chronic pain tends to last longer than it should, so under Moseley’s theory, it’s less about tissue and more about maladaptive output from the brain.

Warning signs of chronic pain include:

• Fear/catastrophising
• Lower self-efficacy
• Depressive symptoms
• Workplace factors
• Adversarial RTW processes

Some of the early warnings of pain disability and job loss include:

• Belief that back pain is harmful or potentially severely disabling
• Fear and avoidance of activity or movement
• Tendency to low mood and withdrawal from social interaction
• Expectation of passive treatment rather than a belief that active participation will help

Methods of self-managing chronic pain may include slow breathing, with a focus on the breath not the pain. This may be difficult to master initially, but may prove worthwhile.

Dr Graham noted that three forms of communication are available to psychologists: following, directing and guiding. It’s important for psychologists to understand which communication style they predominantly use and to develop the other ones further.

There is a natural human tendency to resist persuasion. On the cusp of making change, the psychologist may argue one side and the client may respond with reinforcing the other.

The goal is to evoke arguments for change from the patient or client. Ask about exceptions to global statements such as ‘I can’t do anything.’ Listen to and attend to change talk.

During the transition from acute to chronic, patients may impacted by systematic influences. The search for a cure requires trust and resilience, although transition is often experienced as difficult.

Dr Graham said that essentially we are encouraging clients/patients to become better or choose to be willing to live with an unwanted circumstance. One of the most challenging aspects of this is the experience of uncertainty.

The patient’s identity has often changed through the pain, and moving forward needs to include the acknowledgement of this loss and the development of the skill set to manage both suffering and uncertainty.

If you notice a patient saying ‘I can’t’ a lot, try changing the framework and ask them what they can do. This helps to build positivity and build self-efficacy. In preparation for this phase, it may be useful to discuss pain versus damage, normalising loss, grief and adjustment, discussing pain as physical and psychological, return to work as part of healing, and understanding the process of other stakeholders.

This can evolve into action through discussion of integration and practice, flare-up management, reconnection with the workplace, problem solving and coping, and facilitating responsibility for the process.

For treaters this involves empathy, relational competency and motivational interviewing skills. It requires helping the patient to get used to their situation, monitoring and responding to their points of resistance, and expecting  setbacks.

Source: At Work, Issue 93, Summer 2018: Institute for Work & Health, Toronto

Reproduced with permission from Return to Work Matters Ptd Ltd. For more articles, visit here.