Helping Our Patient in Pain Become More Resilient

[AJ Lievre]

An article by Tatta et al. was published in PTJ in November of 2023. They propose a model for addressing musculoskeletal pain that is process oriented rather than a BPS model, which can become compartmentalized. Additionally, this model combines the tenets of Cognitive Functional Therapy and a psychological model of health theory called salutogenesis. One of the principles of salutogenesis is something called sense of coherence which is about the resiliency of the individual when facing adversity.
Check out these 2 articles and comment on what you learn and how you might help your patients in pain become more resilient in the face of adversity. Are there any specific patients that come to mind where you felt they lacked resiliency, and how you might help patients like them in the future?

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[Farisshd]

I think as physical therapists we often naturally begin to pull from many skill sets, and psychology is one that is very useful in managing certain patient populations. The PRISM framework suggested here offers some useful structure, and breaks down the different aspects of the patient background and experience that may be useful for those struggling with pain management. However, the fact that PTs are not recognized as professionals that can effectively bill for the time these techniques are utilized and the fact that more studies are warranted prior to adopting this approach makes it less likely to be fully utilized.
With that said, I have had several patients that seem to lack resilience, and feel more of a victim when they may be in better physical and functional shape than others who have a better outlook and have positive outlook.
Having this theoretical framework in my back pocket will allow me to have a quick reference to identify specific areas that I light be able to highlight and help the patient begin to feel more empowered and build a more resilient thought process.
Starting with identification of where the patient stands in each process in a specific domain will be helpful and creating a sense of empowerment and shifting the patients beliefs and behaviors, while continuing to be productive and avoiding significant interruptions in billable time.

[Farisshd]

Further, while I feel many of us intuitively recognize and attempt to address/buffer the negativity leading to a disability spiral, it can be a challenge. Helping the patient to recognize these negative beliefs and utilizing the structure proposed in the PRISM model may be useful to begin introducing those positive belief and processes that lead to the upward trend depicted in the sustainability spiral and building a sense of empowerment and decreasing tendency for rumination, fear, and further anxiety.

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