Highlights
- •Pain is a subjective experience that results from the complex modulation of nociception conveyed to the brain via the nervous system.
- •Psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, physical function, and treatment outcomes.
- •Several evidence-based interventions to address pain-related psychological risk factors are available and can be integrated into hand therapy.
Abstract
Study Design
Literature review.
Introduction
Pain is a subjective experience that results from the modulation of nociception conveyed
to the brain via the nervous system. Perception of pain takes place when potential
or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced
by one's cognitions and emotions based on her/his pain-related experiences, which
are processed in the forebrain and limbic areas of the brain. Unarguably, patients'
psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression),
and pain-related behaviors (eg, avoidance) can influence perceived pain intensity,
disability, and treatment outcomes. Therefore, hand therapists should address the
patient pain experience using a biopsychosocial approach. However, in hand therapy,
a biomedical perspective predominates in pain management by focusing solely on tissue
healing.
Purpose of the Study
This review aims to raise awareness among hand therapists of the impact of pain-related
psychological factors.
Methods and Results
This literature review allowed to describe (1) how the neurophysiological mechanisms
of pain can be influenced by various psychological factors, (2) several evidence-based
interventions that can be integrated into hand therapy to address these psychological
issues, and (3) some approaches of psychotherapy for patients with maladaptive pain
experiences.
Discussion and Conclusion
Restoration of sensory and motor functions as well as alleviating pain is at the core
of hand therapy. Numerous psychological factors including patients' beliefs, cognitions,
and emotions alter their pain experience and may impact on their outcomes. Decoding
the biopsychosocial components of the patients' pain is thus essential for hand therapists.
Keywords
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JHT Read for Credit
Quiz: #542
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.Pain is a perception resulting from signals traveling along
- a.peripheral nerve pathways
- b.dorsal horn pathways
- c.ascending and descending pathways
- d.the epidural skin layer
- a.
- #2.The association of intensity of pain and the severity of the injury is
- a.often weak
- b.directly proportionate
- c.without any correlation
- d.readily quantifiable
- a.
- #3.The concept of nociplastic pain connotes pain
- a.following neuroma formation
- b.which is accentuated following peripheral nerve injury
- c.which is centrally modulated following crush injury
- d.when there is no evidence of actual physical tissue insult
- a.
- #4.Psychotherapy is recommended for
- a.all patients with significant pain
- b.all patients exhibiting allodynia
- c.patients exhibiting maladaptive pain experience
- d.only patients with CRPS lasting more than 6 months
- a.
- #5.The authors strongly advocate a biopsychosocial approach to pain management rather than the more traditional biomedical approach
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: February 12, 2018
Accepted:
December 16,
2017
Received:
October 30,
2017
Footnotes
Conflicts of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Identification
Copyright
© 2018 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
