Presentation is loading. Please wait.

Presentation is loading. Please wait.

Active despite pain: the role of pain models in chronic musculoskeletal pain Stephen Morley Leeds Institute of Health Sciences.

Similar presentations


Presentation on theme: "Active despite pain: the role of pain models in chronic musculoskeletal pain Stephen Morley Leeds Institute of Health Sciences."— Presentation transcript:

1 Active despite pain: the role of pain models in chronic musculoskeletal pain Stephen Morley Leeds Institute of Health Sciences

2 Aims 1.Review the relationship between pain and behaviour 2.Focus on seemingly counter intuitive relationship between pain and increased (over) activity 3.Implications –aetiological accounts –maintenance of disorder –developing rational treatment model

3 Pain – perception for action Attention : efficient engagement in current task Vs awareness of higher priority demands A dynamic process Response Pain stimulus Pain signal Task (signal) Pain characteristics Novelty & unpredictability Intensity Threat value Person characteristics Fear of pain Catastrophising Task effects Competitive value of primary task Experimentally difficult

4 Naïve model for Rest vs Be active

5 Disrupt ongoing behaviour – Reduce activity Attend to ameliorating pain – Rest/recuperate Except when other tasks have greater imperative

6 Chronic pain Behaviour as a public event –Influence of reinforcers –Establishment of discriminative stimuli – context effects Examples –Pain report –Facial display –Use of aids –Walking speed –Medication consumption

7 Chronic pain S D the presence of others From Lousberg et al Pain 1992; 51: 75–9

8 Pain and increased behavioural activity Two issues 1.Aetiological a)Persistence ► injury b)Maintenance injury ►continuation despite pain vs rest recuperation 2.Fluctuations in pain ◄►behaviour e.g. rest- activity cycling / pacing NB Transdiagnostic nature of these accounts

9 Two aetiological accounts Ergomania (pre morbid) (van Houdenhove) –Based in psychodynamic terminology –Not easy to operationalize –Relative context independent Avoidance-endurance (Hasenbring) –Catastrophising ► fear avoidance –Suppression ► switching attention: irritable & depressed –Minimizing ► ignore pain: positive mood & overexertion

10 Mood as input Interaction between mood as information and characteristics of the task Task characteristics = rules about when to Stop  As many as can (AMAC) – ‘when you’re satisfied’  Feel like discontinuing (FLDC) – ‘not enjoying’

11 Evidence from empirical studies

12 Mood as input model for pain

13 Some issues The relationship between behaviour and mood: the possible role of goals The development of goal preferences –Prevention vs promotion focus –State vs action preferences Multiple goals / tasks – the dynamics of pacing Association of stop rules and tasks –Doing the dishes vs. writing a novel

14 Approach goals discrepancy reducing Elation / joy Depression Neutral Relief Anxiety Neutral Hope Tension Avoidance goals discrepancy increasing Doing poorly Doing well Frustration Eagerness

15 Passive and Active avoidance Passive ‘don’t act and be safe Fear-avoidance DO NOTHING BE ACTIVE Doing poorly Doing well Active Do act or else …. Persistence BE ACTIVE DO NOTHING

16 INJURY/STRAIN DISABILITY DISUSE PASSIVE AVOIDANCE PAIN Vlaeyen & Morley, Pain 2004 Catastrophic misinterpretations Enjoy ? INJURY/STRAIN PAIN OVERUSE ACTIVE AVOIDANCE Inflated Responsibility Enough ?

17 Avoiding, pacing and ‘doing’ From McCracken & Samuel Pain2007; 130: AvoidPaceConf Pace.51 Conf Uptime Disab

18 GOAL 2: passive avoidance GOAL 1: active avoidance Pacing Exposure

19 Thanks to … David Griffith (UK) Johan Vlaeyen (B)


Download ppt "Active despite pain: the role of pain models in chronic musculoskeletal pain Stephen Morley Leeds Institute of Health Sciences."

Similar presentations


Ads by Google