Some clients we see in clinic have anxiety, depression, bi-polar, obsessive compulsive disorder, post traumatic stress disorder which may contribute to their physical presentation. We ask you about these in clinic as this may affect our approach and how we work with you.
This year has been a tough one for us all due to the global pandemic. We haven’t been able to see friends/family, some of us may have had time off work or even lost our job, and we might have had to self-isolate which could all have had an impact on our mental health. As a result of this, our psychological state may influence our physical health. For example, we may have less inclination to maintain good posture or lack motivation to exercise and subsequently, this could cause musculoskeletal problems such as back stiffness and pain. You may find it useful to review our August blog on ‘good posture.’
Our mental health can affect our pain threshold1 for example, a heightened state of anxiety/stress may lead to a lower pain threshold. Chronic pain can also affect your mental health1.
In this blog we aim to explore chronic pain, mental health, how both of these these affect our physiotherapy approach and the effects of exercise on physical and mental health.
Chronic pain can be recognised as: pain that persists past normal healing time and usually pain is classed as chronic when it lasts or recurs for more than three to six months2.
One study has shown an association between chronic pain and reduced physical activity3,4,5 which in turn may contribute to physical health problems.
Another article has shown that people with chronic pain reported the following functional limitations and symptoms in daily life: deficient energy, muscular discomfort, physical mobility limitations e.g. lifting groceries, climbing stairs, and stooping6. Interestingly, women with chronic pain tend to refrain from physical activity in comparison to men6.
Over 85% of chronic pain patients report they have difficulty sleeping1.
How does chronic pain and mental health problems affect physiotherapy intervention?
When people present with mental health problems and/or chronic pain in clinic, we tend to take more of a holistic approach to treatment to help improve outcomes, this includes looking at the person as a whole, instead of only focussing on their physical symptoms. A holistic approach can include exploring ones physical, emotional, social and spiritual wellbeing.
Research has highlighted the correlation between depression and knee pain and the need for a biopsychosocial approach to treatment to potentially improve outcomes7.
Another study has shown the association between mental health, increased Osteoarthritis (OA) pain and increased risk of OA flare ups8.
Exercise & mental health
Exercise can benefit our physical health, including reducing the risk of: type 2 Diabetes, Cardiovascular Disease and Osteoporosis9. In addition to this, specific exercise interventions can also help to improve mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function10.
If in a state of emergency/crisis with regards to your mental health please either:11
- Ring 999 for an ambulance
- Go straight to A&E, if able
- Or call your local crisis team, if you have their number
I hope you found our December blog useful and enjoyed reading it.
If you have any feedback please do not hesitate to contact me through The Physiotherapy Clinic email or phone number.
Have a lovely Christmas & see you in the New Year!
(article written on 9/12/2020)
- https://www.floridamedicalclinic.com/blog/psychological-impact-chronic-pain/#:~:text=Your%20mental%20state%20can%20exacerbate,that%20they%20had%20difficulty%20sleeping accessed 9/12/2020
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/ accessed 9/12/2020, Rolf-Detlef Treede,aWinfried Rief,b Antonia Barke,b,* Qasim Aziz,c Michael I. Bennett,d Rafael Benoliel,e Milton Cohen,f Stefan Evers,g Nanna B. Finnerup,h Michael B. First,i Maria Adele Giamberardino,j Stein Kaasa,k Eva Kosek,l Patricia Lavand’homme,m Michael Nicholas,n Serge Perrot,o Joachim Scholz,p Stephan Schug,q Blair H. Smith,r Peter Svensson,s,t Johan W.S. Vlaeyen,u,v and Shuu-Jiun WangwPain Classification of chronic pain for ICD-11, Pain, 2015;156(6): 1003–1007.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935027/ accessed 9/12/2020, María Dueñas,1Begoña Ojeda,2 Alejandro Salazar,2 Juan Antonio Mico,3 and Inmaculada Failde2 A review of chronic pain impact on patients, their social environment and the health care system, J Pain Res, 2016;9: 457–467.
- https://journals.lww.com/psychosomaticmedicine/Abstract/2015/04000/Longitudinal_Associations_Between_Depression,.14.aspx accessed 9/12/2020, Lerman SF, Rudich Z, Brill S, Shalev H, Shahar G. Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients, Psychosom Med, 2015;77(3):333–341
- https://www.sciencedirect.com/science/article/pii/S1526590012006645 accessed 9/12/2020, Azevedo LF, Costa-Pereira A, Mendonca L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal, J Pain, 2012;13(8):773–783
- https://pubmed.ncbi.nlm.nih.gov/23126682/ accessed 9/12/2020, S V Björnsdóttir1, S H Jónsson, U A Valdimarsdóttir Functional limitations and physical symptoms of individuals with chronic pain, Scand J Rheumatol, 2013;42(1):59-70
- https://link.springer.com/article/10.1186/1471-2474-15-10 accessed 9/12/2020 Pyae P Phyomaung, Julia Dubowitz, Flavia M Cicuttini, Sanduni Fernando, Anita E Wluka, Paul Raaijmaakers, Yuanyuan Wang& Donna M Urquhart Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review BMC Musculoskeletal Disorders 2014;volume 15, Article number: 10
- https://www.sciencedirect.com/science/article/pii/S106345841000083X accessed 9/12/2020, L.Wise†‡J.Niu†Y.Zhang†N.Wang†§J.M.Jordan∥E.Choy¶D.J.Hunter†# (2009), Psychological factors and their relation to osteoarthritis pain, Osteoarthritis and Cartilage Volume 18, Issue 7, July 2010, Pages 883-887
- https://www.betterhealth.vic.gov.au/health/healthyliving/physical-activity-its-important#:~:text=Physical%20activity%20or%20exercise%20can,improve%20your%20quality%20of%20life. Accessed 9/12/2020
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/ accessed 9/12/2020, Ashish Sharma, M.D.,1Vishal Madaan, M.D.,2 and Frederick D. Petty, M.D., Ph.D.3 Exercise for mental health Prim Care Companion J Clin Psychiatry. 2006; 8(2): 106.
- https://www.mind.org.uk/information-support/guides-to-support-and-services/crisis-services/getting-help-in-a-crisis/ accessed 9/12/2020