Beliefs about the nature of pain
Pain researchers have identified a number of different types of belief or appraisal about the nature of pain. Beliefs about the extent to which pain can be controlled would appear to be one of the most powerful determinants of adjustment to pain and the development of incapacity, possibly
Box 23.4 Key educational messages
- ? The perception of pain is a consequence of the interpretation of pain which is shaped by our memories and prior experience.
- ? Our response to pain is influenced both by our beliefs about it and the emotional significance we attribute to it.
- ? Back pain patients’ beliefs, expectations, and preferences should be elicited and used in the clinical decision-making process to help select treatments that have the best chance of promoting patient recovery and return to work.
- ? Beliefs about the nature of pain, fears of hurting, harming, and further injury, and selfefficacy beliefs are the most important beliefs to consider.
- ? The attitudes and beliefs of healthcare practitioners are part of the dynamic interaction within back pain consultations, and are significantly associated with the advice and recommendations they give to patients and their treatment decisions.
- ? Societal influences play an important role in determining the outcome of back pain and development of disability.
mediating the influence of pain and depression. These core constructs can also be viewed as specific therapeutic targets. Correction of fundamental misunderstandings about the nature of pain, its effects and probable course are likely not only to facilitate optimal management but also prevent unnecessary iatrogenic misunderstandings and distress. An important stage in optimal adaptation to a chronic condition seems to depend upon patients’ ability to come to terms with what they can and cannot control. This is turn may be affected by specific fears of hurting, harming, and further injury.