5How important are back pain beliefs and expectations for satisfactory recovery from back pain?
Section snippets
The nature of pain perception
Recent advances in neuro-imaging are leading to the identification of pain pathways and parts of the brain associated with the shaping of pain perception. For example, functional magnetic resonance imaging (fMRI) has led to new understandings about how a painful stimulus is translated into pain perception in the brain. These new understandings have begun to clarify the cascade of events that follows the arrival of a ‘pain signal’, after which different parts of the brain become activated. It
Types of beliefs
DeGood and Tait identify four principal dimensions of belief (regarding aetiology, diagnostics, treatment expectations and outcome goals) [24]. For purposes of clinical management, the most influential types of belief appear to be beliefs about the nature of pain, specific fears of hurting, harming and further injury and self-efficacy beliefs. Other sorts of beliefs influencing consulting and participation in treatment are reviewed in the next section.
Beliefs about the nature of pain
Pain researchers have identified a number
The decision to consult
Patients' attitudes, perceptions and beliefs about their back pain, its likely course and the usefulness of specific treatments may influence an individual's decision to seek health care and to embark on complete treatment, although the evidence to support this is limited by the challenges of data collection from those who do not seek health care. There is evidence from community surveys that about half of those who experience low back pain in a 1-year period will consult an HCP, and that while
The nature of health-care practitioners' beliefs and treatment orientations
Recently, more attention has been drawn to the role of HCP's beliefs, preferences and expectations since they are likely to be an integral part of the health-care process, helping to determine success or failure of treatment. The characteristics of the HCP, such as their status as professionals, their therapeutic style, the words they use with patients, their beliefs about the problem and their confidence or conviction in treatments, have all been suggested as non-specific effects of treatment
Explaining the difference between acute and chronic/recurrent pain studies of population beliefs
While prior back trouble is a strong predictor of future recurrence [78], recovery from a prior episode of back pain results in a better set of beliefs about its consequences. Individuals who have recovered from an episode of back pain in the past have better beliefs about the consequences of back pain than individuals who have never experienced back pain as well as those with current or more recent back pain [79]. This has led to the proposal that those who have survived previous episodes of
Conclusions
Patient beliefs are a core part of pain perception and response to pain. The role of central processes in pain perception, illuminated by advances in technology offer the possibility not only of new understandings on the nature of pain itself but also of new intervention approaches targeting patients' beliefs and expectations, enhancing pain control and improving psychological adjustment. We need to tackle the problem of pain not only at the level of the individual but at a professional and
References (95)
- et al.
Patient-centredness: a conceptual framework and review of the empirical literature
Soc Sci Med
(2000) - et al.
The cerebral signature for pain perception and its modulation
Neuron
(2007) - et al.
A neurocognitive model of attention to pain: behavioral and neuroimaging evidence
Pain
(2009) - et al.
Hypervigilance to pain: an experimental and clinical analysis
Pain
(2005) Editorial: perspectives on hypervigilance
Pain
(2009)- et al.
Coping with rheumatoid arthritis: catastrophizing as a maladaptive strategy
Pain
(1989) - et al.
Contextual determinants of pain judgements
Pain
(2008) - et al.
Psychological predictors of pain expression and activity intolerance in chronic pain patients
Pain
(2008) - et al.
The influence of communication goals and physical demands on different dimensions of pain behavior
Pain
(2006) Commentary: the importance of emotional processes in the modulation of pain
Pain
(2009)