The Importance of Clarifying Hurt vs. Harm for Improved Outcomes
Reading time: 4 minutes
This week’s blog provides four quick chronic pain concepts, including practical tips for relaying Hurt vs. Harm, plus a downloadable infographic to help educate patients for improved clinical outcomes.
1. Yellow Flags Delay Recovery
“Patients who report maladaptive psychosocial factors have a significant increase in the risk of poor outcome.” (1)
Evidence-based chiropractors are painfully aware of how faulty patient beliefs can delay or halt clinical progress. Two of the most frequently encountered yellow flags include fear avoidance and kinesiophobia, and for LBP patients, fear of movement is overwhelmingly the most common psychosocial roadblock to progress. (2)
2. Chronic Pain is Learned (and sometimes reinforced)
Avoiding discomfort is an instinct for most people; however, that healthy perception can sometimes morph into virtual paralysis. And unhealthy coping strategies fuel chronic pain, which has the potential to lower pain thresholds or even generate referrals to distant sites. This hypersensitization happens primarily in the brain, not at the site of symptoms, meaning patients must reprogram how their mind thinks about everyday activities and movements.
3. Patient Re-Education is Essential
While chiropractic manipulation and manual therapy benefit many musculoskeletal complaints, manual therapy alone can’t overcome unhealthy beliefs. (3) However, multiple studies have shown that patient education can help and is essential for resolving chronic pain.
“Individuals … receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts. (4)
“Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any etiology.” (5)
4. Start with Hurt vs. Harm
Exercise and movement are essential for recovery, and understanding the concept of hurt vs. harm is equally critical to overcoming a fear of movement. So here are five educational points to help your patients cope.
Stay Active - there is a vast difference between hurt and harm. Just because something hurts does not mean it’s harming you. Movement can be uncomfortable, but it does not necessarily mean that you are harming yourself. Recognize that the amount of pain you are experiencing does not correlate with the amount of tissue damage. Slow down for acute or radiating pain, but unless directed otherwise, nudge into manageable discomfort.
No Pain, No Gain Is Not A Proper Mindset Either - Overdoing it will often set you back. The balanced sore but safe approach is usually best.
Start Slowly - Pick one activity you would like to perform, i.e., walking. Identify your baseline for what you can comfortably achieve, i.e., 5 minutes on a flat surface, then nudge it each day, i.e., add one minute or increase the pace slightly. Be patient.
Refocus - It’s natural to focus on discomfort, but next time you sense irritation, refocus your attention to another healthy part of your body. i.e., when your back hurts, focus intently on how good one specific knuckle feels, or sing a song in your head. Your brain can de-sensitize an area whenever you focus on something else. This can trigger lasting changes in your brain that will help you recover.
Continually Refuel Your Brain - Choose a healthy diet with plenty of water, and strive for 7-9 hours of quality sleep each night.
Want to share this information with your patients? Subscribers can download the ChiroUp Understanding Chronic Pain infographic.
Download now!
WANT TO LEARN MORE?
We invite you to check out our webinar: The Invisible Disability: 3 Solutions For Chronic Pain. Join Dr. Steele as he discusses the ideology and what we, as Evidence-Based chiropractors, can do so well for this condition.
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1. Cruz EB, Canhão H, Fernandes R, Caeiro C, Branco JC, Rodrigues AM, Pimentel-Santos F, Gomes LA, Paiva S, Pinto I, Moniz R. Prognostic indicators for poor outcomes in low back pain patients consulted in primary care. Plos one. 2020 Mar 27;15(3):e0229265.
2. Patel MS, Lee KC, Dhake RP, Longworth S, Sell P. Ability of Spine Specialists to Identify Psychosocial Risk Factors as Obstacles to Recovery in Patients with Low Back Pain-Related Disorders. Asian Spine Journal. 2021 Apr;15(2):224.
3. Kamonseki DH, Christenson P, Rezvanifar SC, Calixtre LB. Effects of manual therapy on fear avoidance, kinesiophobia and pain catastrophizing in individuals with chronic musculoskeletal pain: Systematic review and meta-analysis. Musculoskeletal Science and Practice. 2021 Feb 1;51:102311. Link
4. Mittinty MM, Vanlint S, Stocks N, Mittinty MN, Moseley GL. Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scandinavian journal of pain. 2018 Apr 25;18(2):211-9. Link
5. Joypaul S, Kelly F, McMillan SS, King MA. Multi-disciplinary interventions for chronic pain involving education: A systematic review. PloS one. 2019;14(10). Link
