It’s important for doctors and patients alike to understand what factors play into the transition from acute to chronic back pain. It may seem that the only real factor is the cause and extent of injury, but this is not the case. A person’s cognitive orientation toward pain as well as the behaviors they adopt in the face of pain can be the decisive factors in determining whether pain goes away or sticks around.
Researchers recently tracked 315 patients who reported to a doctor with first-time back pain. They measured cognitive factors at baseline, three weeks, six weeks, 12 weeks and six months along with functional limitations associated with back pain.
The researchers found that the presence of maladaptive cognitions at 12 weeks was the best indicator of whose pain and functional limitations would persist at the six-month follow-up. The predictive value of 12-week cognitive measures was 90%.
See more on the study at www.ncbi.nlm.nih.gov.
The term “maladaptive” means that which misdirects or steers away from adaptation; cognitions are thoughts, feelings and beliefs. Taken together, then, maladaptive cognitions in the pain patient are thoughts, beliefs and feelings about pain that prevent the patient from adapting appropriately.
Examples of maladaptive cognitions related to pain are catastrophizing and kinesiophobia, or the fear of movement. Catastrophizing occurs when a patient thinks and suspects the worst – for example, “I’m never going to get better,” and “I’m never going to be able to resume activities I love.” Kinesiophobia interferes with a person’s willingness to stay physically active, which can lead to physical deconditioning and worsened pain. Aside from their effects on activity levels, maladaptive cognitions can actually activate areas of the brain involved in processing pain signals, creating worsened sensory responses to pain. This means that how we feel emotionally about pain can affect how we feel it physically.
Identifying maladaptive cognitions early on and nipping them in the bud may be an important part of interrupting the transition from acute to chronic back pain. Patients should be aware of their psychological and emotional responses to pain, and medical professionals should pay attention to them as well. Early cognitive behavioral therapy may be the key to preventing chronic pain in some patients. Graded exposure therapy, in which patients actively challenge their fear of movement, may also be indicated.