OCCUPATIONAL - Risk Management & Chronic Pain

Question 1

What are the 3 steps to risk management?

Answer 1

Risk management is the process of recognizing what has the capacity to cause harm to people/property and then doing something to prevent this.

1. Hazard ID (physical, mechanical, biological, cognitive)
2. Risk Assessment (eg. RULA)
3. Risk control (start with the best option and then work your way down; ie if you can’t REMOVE the risk then LESSEN it)

Question 2

What are the most challenging patient behaviors and why are they significant in patient management?

Answer 2

1. Fear
2. Catastrophization
3. Injustice
4. Beliefs

Understanding which of these applies most to the patient in front of you can help you target your management optimally.

Question 3

How can you address perceived injustice in a patient?

Answer 3

• they believe they’ve been victimized and ANGER is often the most common reaction
  1. communicate that you’ve received their emotional message
  2. align yourself as an ally not an enemy!
  3. walk them through thought monitoring/re-appraisal

Question 4

How can you address a pt’s beliefs?

Answer 4

1. Reflective questioning
2. Educate!
   - provide facts gently (eg. XR findings don’t correlate with symptoms; pain doesn’t mean damage)
   - use Tampa Scale for Kinesiophobia to measure their beliefs about their pain
   - reconceptualize pain
3. Provide an experience that is INCOMPATIBLE with their beliefs - the best way!

Question 5

What are the subcategories of catastrophization?

Answer 5

1. Rumination (“I can’t seem to keep it out of my mind”)
2. Magnification (“I wonder if something serious may happen”)
3. Helplessness (“There’s nothing I can do to reduce the intensity of the pain”)

Question 6

Why is catastrophization important to address?

Answer 6

Is associated with a host of bad outcomes!

• post surgical pain
• analgesic use
• LOS in hospital
• lower QoL
• mental health problems
• work absence

Question 7

How can you address pt’s catastrophization?

Answer 7

1. Communicate to them that you’ve received their emotional message
2. DON’T tell them not to think about it
3. Let them talk
4. Thought monitoring/emotional problem solving

Question 8

How can you address a pt’s fear?

Answer 8

1. Educate - help them to understand link between fear and pain; expose them to positive stories
2. GRADED exposure
   - least threatening to most

Question 9

What is the role of treatment in chronic pain?

Answer 9

Be aware that treatment can increase the pain experience.

After the injury that leads to pain experience - pt can go into catastrophization -> fear of movement -> hypersensitivity -> deconditioning/depression -> more pain etc

A treatment (eg passive or telling patient their degenerated) can play into negative beliefs and facilitate this vicious cycle