In our first newsletter for referrers and case managers we looked at the Biopsychosocial Model, and the International Association for the Study of Pain’s definition from which all pain needs to be considered.
One of the most common and well-studied psychosocial obstacles to recovery is pain catastrophizing which is one of the outcomes measured within the pain service contract. Put simply - the more we freak out about the pain, the worse it gets!
The diagram above explains the pain catastrophizing model in more detail. Patients
can be considered as either ‘copers’ or ‘avoiders’. It is in everyone's best interest to address the Biopsychosocial factors that are often present in those patients who are not coping with their pain - this is the main impetus of the pain service contract.
Pain catastrophizing can result in what we would think of as the simplest of injuries (sprain/strain read codes) snow balling into a disability lasting well in excess of the expected recovery time. Elevated pain catastrophizing is associated with greater disability, higher pain intensity, increased levels of anxiety and depression, absence from work, and higher health care utilization. It should be noted that pain catastrophization is not a conscious
choice or personality failing - rather a subconscious reaction to a painful event.
The positive news is that pain catastrophizing is a modifiable obstacle to recovery and responds positively to multi-disciplinary, stepped care approaches such as our program at Integrative Pain Care. The following figure from our 2017 Electronic Persistent Pain Outcomes Collaboration (EPPOC) report from Wollongong University clearly demonstrates the positive impact our treatment strategy has on pain catastrophization.