Biopsychosocial approach to pain management

Question 1

Neuromatrix

Answer 1

• Input = cognitive, emotion, sensory

* Output = pain, motor, stress, emotion

Question 2

Aspects to intervention planning

Answer 2

• Pain type
• Somatic (msk) structure
• Thoughts and beliefs
• Emotions
• Behaviours
• Social
• Motivation

Question 3

Pain types/structure management

Answer 3

• Nociceptive = RICER, NSAIDs, gradual return to activity, progressive strengthening
• Nociceptive/inflammatory (e.g. rheumatoid arthritis) = anti-inflam
• Nociceptive/ischemic pain = movement, strengthening, posture change/avoidance
• Peripheral neuropathic pain = peripheral pain medication
• Chronic/centrally maintained pain = holistic approach/neuromatrix

Question 4

Thoughts and beliefs

Answer 4

• Pain education/explain pain approach = educating how nociception works, role of brain and other neuromatrix factors in generating pain response
• Cognitive behavioural approach = change beliefs about pain, convert maladaptive behaviours and beliefs
• Graded exposure therapy = reduce catastrophising, educating about pacing
o Tissue tolerance line > pain produced line

Question 5

Emotions

Answer 5

• Assisting with identification and treatment of depression, anxiety stress
• Treatment options include-
o CV exercise
o Cognitive behavioural therapy- change beliefs and attitudes
o Behavioural therapy- rewarding activities, achieving satisfaction

Question 6

Behaviours

Answer 6

• Maladaptive behaviours = bracing/guarding/spasms, fear avoidance, overly protective
• Treatment options-
o Educate normal movement, activity, pacing- graded exposure, lifestyle mods
o Improve msk function- exercise training/conditioning
o Reduce excessive guarding/spasms- manipulation/relaxation, meditation

Question 7

Social

Answer 7

• Poor factors include work, family etc.

* Treatment should include collaborative family/occupation education/counselling