L2: Biopsychosocial Model Flashcards
The lifetime prevalence of low back pain is reported to be as high as _____%.
84
11–12% of the population have low back pain and about 50% of patients recover completely in ___ weeks. Most people (80%) recover within _____ weeks. 80% chance of a recurrence within ____ months
2; 4-6; 12
50% of women will develop ____ or ______ during pregnancy
LBP; pelvic pain
Is LBP or pelvic pain more common during pregnancy?
Pelvic pain
________ was rated as the health condition responsible for the most years lived with disability when all common diseases were considered. Why?
Lower back pain (LBP); very common and affects activities of daily life
There is no relationship between the findings on MRI and the likelihood of getting LBP, the severity of symptoms or the prognosis. True or false.
True
Up to half of all older people without LBP show evidence of lumbar facet joint osteoarthritis on CT. True or false.
True
the only degenerative feature associated with self-reported LBP is _____.
spinal stenosis
80% of people without LBP show at least one mild disc _____ or a disc ______ in the lumbar spine.
protrusion; herniation
____% of people have two or more of these degenerative changes
40
How does low back pain start? (aetiology of LBP). What are 3 factors that trigger it?
Physical factors Psychosocial factors A combination of the two
What are 3 examples of physical factors that start low back pain?
- Bending
- lifting
- twisting
(MOI) (eg. lifting awkwardly)
What are 3 examples of physical factors that trigger low back pain?
- being fatigued
- tired
- stressed
What is an example of a combination of factors that trigger low back pain?
being distracted while lifting
_____ is the single most commonly reported of all self-reported causes.
Lifting
81% of episodes began at _______ (where)
home
About 1/3 of acute LBP _____ (can/cannot) be attributed to an event
cannot
What are 9 factors that are associated with poorer outcomes of LBP? What do these factors highlight?
- higher levels of disability
- presence of sciatic symptoms (radiculopathy)
- older age
- poor general health
- increased psychological or psychosocial distress
- negative cognitive characteristics
- poor relationships with colleagues
- heavy physical work demands
- presence of insurance compensation bio-psycho-social factors associated with developing persistent pain or not having good outcomes
What is the source of of low back pain?
non-specific and musculoskeletal in origin (Are no clinical symptoms (anatomical problem))
What are 5 injuries presenting to primary care with LBP?
- Compression fracture
- Spinal stenosis
- Referred pain from visceral structures
- Tumour or metastasis
- Infection
What are the causes of low back pain?
Are non-specific Fewer than 1% of patients had specific identifiable causes
What is the prevalence of MSK pelvic pain?
Sacroiliac joint (SIJ) pain affects about 15% of individuals with chronic low back pain
Musculoskeletal problems make up about _____ of all causes of chronic pelvic pain.
1/5th
What are 5 predisposing factors of MSK pelvic pain?
- older age
- inflammatory arthritis
- previous spine surgery
- pregnancy
- trauma
Individuals with SIJ pain are ____ (more/less) likely to report a specific onset of symptoms, and experience ______ (unilateral/bilateral) pain below L5 than those with LBP
more; bilateral
_____ (pubic symphysis) among athletes ranges from 0.5 to 6.2 percent
Osteitis pubis
What are 5 misconceptions or beliefs that patients have with LBP?
- Back pain is an indicator of ‘tissue damage’
- The back is easily injured
- The back needs to be ‘protected’ and there are ‘cures’ for back pain
- Many forms of activity – running, bending etc – are dangers and a potential cause of wear and tear.
- The back is ‘difficult’ to heal
What are 3 misconceptions or beliefs that patients have with managing LBP?
- lifting techniques
- postural control
- muscle strengthening as strategies to “protect” the back, reinforcing the belief that the spine is vulnerable
Recovering from low back pain is more related to the skills of the therapist or surgeon than from factors within the patients control
Recovering from low back pain is more related to the skills of the therapist or surgeon than from factors within the patients control. True or false.
True
What are 3 factors of patients’ control during treatment/ management?
- Ability to keep active and exercise
- Being positive about recovery
- Strategies to help back
What are 5 themes describing the impact of LBP on the patient?
- It can be undermining
- It can disempower the person
- It can negatively impact on relationships (family and friends, health professionals organisation of care)
- Finding ways to cope is important
- Many have to learn to live with pain
What are 5 things the patient wants to know?
- What’s wrong or what’s happened
- How they can return to engage in meaningful activities
- How they can return to social obligations
- What they can do
- What the future will hold…
What are 2 important things when working with patients?
- Wanting to be heard and believed and validated
- Reassurance that nothing serious has occurred or is occurring
What are 4 things that patients wish to find out about?
- The problem
- The prognosis
- What they can do
- How to manage
Why is it important to give correct and perfectly presented information?
Give skills and confidence to start managing themselves Given information stays with patients for a long time
When are 3 scenarios where patients trust the explanation given by their clinician, who are still the primary source of information and advice?
- They feel the clinician is competent
- They feel they had a thorough assessment
- They respond well to treatment
Information and advice can continue to influence the beliefs of patients regarding LBP for many years. True or false.
True
What are 2 models in regards to patient treatment/management?
- Biomedical model
- Biopsychosocial model
What are 5 set of beliefs in the traditional biomedical model?
- All symptoms arise from an abnormality within the tissues
- All diseases and abnormalities give rise to symptoms either immediately or eventually
- Psychosocial factors are separate to body function
- The patient has little or no responsibility for the presence or cause of illness
- The patient is a passive recipient of treatment
What is the problem with the traditional biomedical model in healthcare?
Looks for ‘cause’ rather than many contributing factors. • Only focusses on ‘diagnosis’ and ‘intervention’. • Provides a narrow view of health It is criticized as a reductionist approach to dealing with a complex problem in a simplistic manner (Simplifying BP to a tissue problem –> NOT GOOD)
What are 4 pieces of traditional information and advice about back pain based on a biomedical model that are emphasised. How is this a problem?
- anatomy and biomechanics of the spine
- explaining pain from only a ‘tissue’ level
- activity avoidance or brace to ‘protect’ the back
- ergonomic advice to protect the spine Which can all make patients worse!
The importance of ______, ___, _______ and _____ factors in LBP has required a huge shift in how we approach assessment and management of the patient with LBP
physical, cognitive, affective, sociooccupational
Mounting research evidence indicating better patient outcomes with the ______ model.
Biopsychosocial
What are the 3 aspects of the biopsychosocial model?
- Bio-physical
- Psychological
- Social
What are 4 examples if the bio-physical aspect in the biopsychosocial model?
(eg. structural injury–> stress fractures, spinal stenosis)
- Understanding the pathology and structure causing pain (if known).
- Has role in guiding decisions including surgery and other medical interventions (eg facet injections).
- Helps define impairments including sensory, motor, posture that can provide directive for treatment
- Includes pain neuromatrix changes (eg. nervous system changes –> contributes to chronic pain)
What is an example of the psychological aspect in the biopsychosocial model?
Widely recognised that psychological factors influence the presentation of low back and pelvic pain and strongly influence recovery
What is an example of the social aspect in the biopsychosocial model?
(eg. Work and relationships) Job satisfaction, support, stress and social requirements of an individual can influence pain, coping and recovery
Addressing structural/mechanical factors in isolation without considering the whole person is _____ (scientific/unscientific) and provides _____ (poor/good) clinical outcomes
unscientific; poor
When we target treatments to benefit the range of factors that contribute to back pain, including lifestyle, beliefs about pain and certain structural factors, the effectiveness of rehabilitation interventions _____ (improves/declines) dramatically
improves
What are 3 assessment aims for patients in the interview and physical exam?
- identifying maladaptive beliefs (negative beliefs, fear avoidance, catastrophising, hypervigilance)
- pain behaviours
- movement behaviours
Why is what we explain or say to a patient is important?
patients with LBP who are given an explanation of their condition that describes “pathology” for back pain are more likely to develop persistent pain (Eg. disbulges, tears, back is unstable –> can cause chronic pain) • when patients are given conflicting information they are more likely to be fear-avoidant and pessimistic about recovery (Eg. your back is injured, inflammed ..etc but I still want you to continue to move (conflicting movement–> fear avoidance))
patients with LBP who are given an explanation of their condition that describes “pathology” for back pain are _____ (more/less) likely to develop persistent pain
more
What are 8 features in the Contemporary Biopsychosocial Approach?
- Rule out serious disease (Red flags –> need to be referred)
- Determine contributing bio-physical psychological and social factors that (In interview) contribute to patient’s presentation
- Providing effective reassurance
- Normal movement is helpful
- Hurt does not equal harm
- There a number of treatments that can help the pain but long term recovery depends on role of patient.
- Recovery depends on restoring normal function and fitness.
- Positive attitudes and actively participating are important for recovery (Patient is responsible for their recovery (depends on what they are doing)- More active, confident role –> better)
