The severity of a health problem never explains the level of disability alone.
In fact, medical conditions account for the level of disability in only 11 to 12% of cases.
1 What can explain this phenomenon? Pain must be understood as a personal and subjective experience modulated by the impression that an individual has of the immediate consequences of pain on his/her life, future consequences, estimated duration of the problem, emotions that pain arouses, and the strategies (means) he/she can use to feel better.
Therefore, the intensity of pain is the consequence of a stream of physical and psychological events that influence one another.
In short, the way in which an individual interprets the sensory information of pain and perceives its long-term implications, along with his/her (perceived) capacity to deal with such requirements, determine the "experience" of pain(2) and provide guidance for it.
The level of disability following an injury or illness is better determined by an individual's personality traits and beliefs and by his/her environment.
We have developed a guide for rehabilitation workers and program managers for screening cases at risk of becoming chronic sufferers.
In addition, this guide discusses information that must be obtained from an individual with regard to his/her condition to plan a rehabilitation program effectively.
Chronicity Risk Factors If the answer is "yes" to a single one of the following questions, there is a risk of the individual becoming a chronic sufferer.
1.
Does the individual exhibit symptoms or behavior related to psychological distress (fear, anxiety, concerns, depression, substance abuse, somatization)? 2.
Does the individual appear to dramatize his/her situation (amplifying the consequences of his/her current condition)? 3.
Does the individual avoid getting involved in any process likely to improve his/her condition? 4.
Does the individual derive important secondary benefits from his/her condition (i.
e.
more attention from his/her family circle, removal from unpleasant work or a stressful work environment, etc.
)? 5.
Does the individual misunderstand the consequences of his/her health problem, leading him/her to draw wrong and more serious conclusions on his/her situation? 6.
Is the individual passive with regard to his/her treatment? 7.
Has he/she been suffering from pain for more than two months with its intensity showing no signs of subsiding? 8.
Does the individual think that treatments attempted to date have failed? 9.
Is the individual in a situation where he/she has been told that everything is fine, medically speaking, but the pain persists? 10.
Has the individual interrupted or considerably reduced any physical activity? 11.
Is the individual grappling with a dispute over a benefit claim? If the answer is "yes" to a single one of these questions with regard to the individual's situation, there is an important risk of long-term chronic pain and disability.
In order to better determine the individual's situation and provide him/her with the appropriate support to cope with the problem effectively, referral to a clinic specialized in pain management is recommended.
The clinic will be able to evaluate the individual adequately and recommend a rehabilitation plan adapted to his/her condition.
The following section entitled "From Evaluation to a Rehabilitation Plan" discusses the information that a clinic specialized in pain management has to obtain in such circumstances.
From Evaluation to a Rehabilitation Program Before undertaking any rehabilitation program, it is important to obtain precise information on the individual's condition through a six-step evaluation.
Diagnosis The type of pain should be determined based on the physician's diagnosis: o Localized pain o Regional pain o Generalized pain The rehabilitation and pain management program should be adapted to the individual's type of pain.
The program should be entirely different for an individual suffering from generalized pain such as fibromyalgia compared to an individual suffering from local pain such as bursitis.
Psychological Aspects An individual's psychological condition, interpretation of the consequences of pain, understanding of the problem and perception of the resources available for help throughout the rehabilitation process are among the many factors to document.
It should be pointed out that in most cases, these factors have proven to be the most important determinants of the evolution of the individual's condition, regardless of the severity of his/her medical condition.
Therefore, effective treatment involves taking into account an individual's psychological condition.
Muscle Performance Our bones and muscles - the musculoskeletal system-carry us, day in, day out, and enable us to move, exercise and go about our daily activities.
When suffering from pain after an injury, the level of our daily activities decreases, sometimes considerably.
Consequently, muscle mass usually decreases, resulting in loss of strength and stamina.
This loss in physical condition leads to premature fatigability, even during activities normally requiring only very light effort.
Evaluating the level of physical condition determines the cardiopulmonary endurance of an individual and explains the extent to which it plays a role in his/her current condition.
For instance, an individual may think that fatigue and shortness of breath felt when doing simple housekeeping tasks are the result of an injury, whereas this consequence might be due to muscle deconditioning for the most part.
Muscle Physiology Muscle metabolism disorders represent one of the most important causes of myalgia.
Pain of chemical origin - described most often as progressive, shooting and unremitting pain - indicates the possibility of a muscle metabolism problem, thus preventing muscles from adequately using the energy they need to produce efforts required.
From that moment on, an individual feels pain because of muscle metabolic disturbance.
This phenomenon can limit initial rehabilitation potential if an individual is inadvertently asked to do exercises that exceed his/her muscle capacity and generate pain.
Motor Control As soon as pain appears, motor behavior is affected.
An individual does not move in the same way anymore, considerably modifying movement to avoid pain as much as possible.
Even when an injury has healed, this motor behavior often remains; however, because of its ineffectiveness, pain is caused by this very behavior.
Does the individual move naturally and effectively, or has he/she lost all motor effectiveness? This important question will also guide the rehabilitation process.
Biomechanics If an individual suffers from a work injury such as tendonitis (swimmer's shoulder), is it possible that this injury was sustained because he/she did not move his/her muscles in the safest and most conservative manner? This aspect is important in preventing an individual from falling back into old habits and relapsing after having returned to work following a rehabilitation program.
Conclusion Only by considering the condition of each individual from a global perspective, i.
e.
, by taking into account the overall physical, psychological, environmental and behavioural factors that mutually influence pain, can we prevent a problem from becoming chronic and even restore an optimal quality of life in the most complex cases.