MasterclassBeliefs about the body and pain: the critical role in musculoskeletal pain management
Section snippets
Background
Musculoskeletal pain is a multi-factorial condition; it involves complex interactions between structural, physical, psychological, social, lifestyle, and comorbid health factors and is therefore best understood through a biopsychosocial framework.1, 2, 3, 4, 5 While in most cases, musculoskeletal pain is self-limiting, a significant proportion of society go on to experience long term pain and disability. Musculoskeletal pain is now a leading cause of disability world-wide6 and the prevalence of
What are beliefs and how are they formed?
Beliefs can be defined as “Something one accepts as true or real; a firmly held opinion” (Oxford dictionary). While modifiable, the core characteristics of beliefs can make them difficult to identify and target; (i) Beliefs are not always rational i.e. they can persist even after being presented with facts. For example, a patient might believe that structural changes seen on imaging are the source of their musculoskeletal pain, despite being told that the changes reflect ‘normal ageing’ and are
PART 2 – The process of changing beliefs and behaviour
“To understand the sufferer, one must understand the narrative, for it is through the story that the patient's suffering is accessed. This means both hearing the illness story and listening for the suffering narrative therein.”71
In this section, we will use the Common Sense Model (Fig. 1) as a framework to understand patient's beliefs, behavioural and emotional responses to their condition and the process by which change can be facilitated.
Person-centred communication underpins this process.
Person-centred interview
Completion of a body chart and a multidimensional screening questionnaire (e.g. short form Orebro) prior to the interview can provide helpful insight into the patient's perception of their pain.76 Relevant items from the questionnaire can be used to explore patient's beliefs in the interview and examination. For instance, clinicians can use scores in individual items to guide the interview, and to facilitate disclosure about specific factors (e.g. “You scored 8/10 on ‘avoiding painful
Summary
Beliefs about the body and musculoskeletal pain influence a person's behavioural and emotional response to pain. Beliefs are modifiable and should be considered an important target for the management of musculoskeletal pain. Clinicians have an important role to disseminate positive, evidence-based beliefs about musculoskeletal pain to both patients and society in general. However, many clinicians hold erroneous beliefs themselves, while others feel unskilled to explore and target patients’
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interest
JP Caneiro and Peter O'Sullivan deliver educational workshops on patient-centred care for the management of pain. Samantha Bunzli declares no conflict of interest.
Acknowledgements
The authors acknowledge the patient (Jamie E) for sharing his story.
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