The Issue
The relationship between one’s mental health and pain can often be misunderstood. We know the biopsychosocial model is particularly effective when applied to chronic or complex conditions, especially when patients have varying symptoms and outcomes (Kusnanto, Agustian and Hilmanto, 2018). The model is often applied efficiently in injury management practices and with chronic illness within the wider healthcare settings.
However, there is a significant area where practitioners are still likely to identify outdated belief systems and misconceptions. The area in question is with patients who have chronic pain or discomfort who have also not yet had assistance. This could be due to varying reasons as well as simply not recognising a need to seek assistance (perhaps due to life’s other pressures taking over). This would usually mean that the patient is not aware of the relationship between their lifestyle factors and the pain that they experience. The resources available online when searching about their issue are usually objective and focus more on pain and outcomes and less on the biopsychosocial model and pain management. In my clinical experience, this is not helpful as conflicting or fear-provoking information often exacerbates anxieties which could then worsen the pain experience.
This article will convey key information to help patients better understand their pain and its complex relationship with other factors in their life. This has been designed as a patient education tool during the lockdown of COVID-19 to explain why a generalised and overriding situation will also influence their pain and coping capacities.
This article will convey key information to help patients better understand their pain and its complex relationship with other factors in their life. This has been designed as a patient education tool during the lockdown of COVID-19 to explain why a generalised and overriding situation will also influence their pain and coping capacities.
The Biopsychosocial Model
The biopsychosocial model was not created solely for pain or injury. In 1977, George Engel introduced the concept to highlight the importance of understanding psychological and social factors as well as biological factors for overall medicine (Gatchel, 2007). For physio and sports therapy this means considering patient lifestyles, anxieties, coping capacities, workloads, and support networks. With chronic pain and discomfort there is a need to apply this model as chronic pain behaviour cannot be managed in any one area alone.
Identifying Central Sensitisation
When publishing an article regarding mental health in relation to pain, it may attract the attention of chronic pain sufferers. Although the advice outlined is beneficial for those with centralised pain, investigation would be recommended for those who are undiagnosed and suffering from the symptoms outlined below. So before acting on the advice within this article, it is important for you to consider central sensitisation. This is where the body's nervous system becomes abnormally heightened to certain stimulation (sometimes completely normal/ low threat stimulation). If you have hypersensitive pain, you may have to seek further investigation/ diagnosis. Simply put, pain central sensitisation is where more pain facilitating pathways are activated whilst pain inhibiting pathways are not. This means more messages for pain are being sent to the brain than are coming out.
| Signs of Central Sensitisation: Although Central Sensitisation is uncommon please consider these symptoms (they may also help you identify symptoms for others):
| Conditions with Central Sensitisation:
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Pain's Relation to Lockdown
It is important to consider how an ongoing and uncertain situation may influence your pain experience. Even with issues that are mostly minor, an overriding situation such as the lockdown can have a huge impact. The psychological and social elements of the model are well and truly influenced by the pandemic as there is a generalised sense of fear, negativity, and uncertainty.
There are also certain and prolonged restrictions in our daily lives. Even though this does not relate specifically to an injury, for many the impact the lockdown has had on mental health can be enough to affect coping mechanisms, motivation, and reduce positive stimulations. For those reasons, pain or discomfort could be worsening. This could range from a postural dysfunction or swollen joint all the way to a nerve entrapment or ligament sprain.
There are also certain and prolonged restrictions in our daily lives. Even though this does not relate specifically to an injury, for many the impact the lockdown has had on mental health can be enough to affect coping mechanisms, motivation, and reduce positive stimulations. For those reasons, pain or discomfort could be worsening. This could range from a postural dysfunction or swollen joint all the way to a nerve entrapment or ligament sprain.
5 Tips for Lockdown Pain:
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Thank you for reading!
I hope you have enjoyed reading my article on pain experiences in relation to the lockdown. I believe it is important that the public have a greater understanding on how pain behaves in relation to their individual lifestyle. I hope the article highlights the other less-emphasised factors that influence pain and encourages those feeling impacted to take actionable steps. In addition to that, simply knowing that there can be other influences over pain ought to help those who feel confused. Removing added or unnecessary confusion will always produce better outcomes. Whilst understanding that we are not always in full control of every factor, we can take responsibility for the factors we can control.
References:
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