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Do you reflect on your pain?

This blog comes from a reflection I have made myself on my own emotions and thoughts affecting my own pain and injuries and after listening to a conference on this area I wanted to share my reflections with you:

Our thoughts and behaviours are very individual and this depends on our past experiences and what we have learnt from others. It may be easier for me to give an example of how this works so if we have a think about if I was meeting a friend for coffee and then they cancelled last minute as I had just turned up at the cafe.

Potential Thoughts "They have forgotten" "They don't like me" "I have wasted my time" "Has something happened"

Potential Emotions let down, angry worried, anxious frustrated upset

Possible Behaviours confront them call them ignore them in future forgive them

Not all of these thoughts and behaviours are helpful and they may have been created by mind reading thoughts of others and making them our own. Having an awareness of this process can help us review whether our behaviour is justified and can also relate to our patients when they act in ways which appear irrational to us as health professionals.

So lets look at back pain and how this can apply to our injuries:

Potential Thought: I should not bend my back in case my disc pops out.

Potential Emotion: Worried, anxious, fearful.

Potential Behaviour: Avoid bending.

Our thoughts produce feelings which drive us to behave in a certain way. The above example is an unhelpful behaviour as we know that bending and twisting our back is essential for normal function of our spines, but you can see why patients want to avoid it if they have these potential thoughts on their back pain.

I hear a lot of patients who come to me who have been told lots of different things of the causes of there back pain for example they have an worn L4/5 facet or even they were told their spine is out of line. These messages are not helpful to our patients and has the potential to make them worse. If you thought you had degeneration of your L4/5 facet would you believe your back to be a strong structure?

So our job is to help you avoid getting to this point with their beliefs but also to help them understand why these thoughts are potentially harmful and how this relates to their pain.

So when we get these unhelpful thoughts what should we do with them? A good way to start is to think about Thought Validity. Below is a list of questions you could use / think about when either rationalising our thoughts or helping patients to rationalise theirs.

What’s helpful about this thought?

There might not be a helpful element to the thought but it is worth asking the question. What is unhelpful about this thought?

Relate this to the negative emotion that it created (for example, it’s not very pleasant feeling anxious) and to the behaviour that it created (for example, taking excessive rest) Do we have good evidence to support or refute the thought (not just speculation)?

Can we answer these thoughts back when we have them, to stop us automatically acting on them? Hopefully the answer is yes.

So thinking back to a personal example I remember when applying for a physiotherapy job, that I was thinking well if I got the job over someone more experienced them me then people would be thinking why did I get the job instead of them. So lets break it down.

Potential Thought: People think I have less clinical experience Potential Emotion: Worried about interview, guilt of what others are thinking, anxious about not being good enough. Potential Behaviour: Not attending interview, talking self down, under performing

So in terms of an answer back to myself, i realised these thoughts were my own perceptions of myself and not necessarily others I realised that although I may not have had as many clinical years as some of the other candidates in the area I offered something different for example different experiences and skills in service development, different rotations and leadership.

So then looking back to our back pain patient example who wanted to avoid bending.

An answer back could be: It is essential to bend my back for spinal function therefore I should increase my confidence moving into this direction because there is no reason why I can't bend.

This obviously forms part of a thorough assessment and treatment plan.

A great campaign was run by the CSP recently on Back Myths and it is essential we spread the word to our patients please see the link below.

This really just gives a snap shot of how you can change your thoughts and emotions towards your back pain or any other type of pain you could be experiencing.

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