Chronic Pain in Functional Capacity Evaluation: Physical or Psychological?
I'd like to introduce you to one of our guest writers, MaryBeth Plummer, PT. MaryBeth has been a licensed Physical Therapist for 25 years. She owns MBPT, LLC in Albuquerque, NM which specializes in Functional Capacity Evaluations and ergonomics. For MaryBeth's full bio, please check out our Matheson Blog Team page. We're excited to have her on board and here is her first post - and it's a thought-provoking one!
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There are numerous articles, books and internet sites regarding pain. It is somewhat easy to define pain into chronic and acute stages, but more difficult to define the cause of chronic pain. Acute pain is considered a natural and “healthy” pain as a result of trauma or injury. Chronic pain has no specific etiology thus making it poorly understood. Most chronic pain clients that present for Functional Capacity Evaluation (FCE) testing have not had a good response to therapy or invasive procedures, and sometimes continue with prescription medications that are not beneficial.
When a client presents for a Functional Capacity Evaluation, the clinician has about a 4 hour time-frame to assess this person’s ability to perform his/her pre-injury job or if they can perform any other occupation. There is a need to address a client’s perceived level of ability as well as their perceived level of pain as it relates to function for daily tasks and thus incorporate job tasks. There are a number of tools used in the Matheson system for aiding the clinician in assessing pain and a client’s perceived ability to perform functional activities.
As a thinking evaluator, one can assess a person’s predicted ability based on their diagnosis, observation of gait and ability to change positions, as well as performing a musculoskeletal evaluation to determine some baseline predictions for a client undergoing an FCE.
It is sometimes difficult to assess a person’s true abilities if the client is convinced that their pain limits most, or in some cases, all of their activities. This is where compassion meets the need for educating a client on safety during the evaluation and guiding them to try simple activities that encourage increased activity as well building confidence to perform tasks. Therefore, it is important to let a client speak about the emotional trauma of their injury and what they have been through professionally, personally and financially. This can establish a better rapport and a sense of trust in order to try lifting activities or other postural activities to build confidence in the client’s perceived ability instead of a perceived inability.
Our job is not to judge whether or not a person’s pain complaints are true or authentic, but to encourage and perhaps educate them about performing tasks in a modified manner to accommodate for their pain complaints.
There is a mind and body connection which is evidenced by the effect of depression in the mind affecting symptoms of pain and dysfunction in the body (muscle aches and pains, skin and hair problems, sleep disorders, etc). A paper in Spine, Vol 17, No 6, supplemental pages 138-144 (1992) showed correlation in the success of spinal surgery patients as it related to childhood traumas. This study indicated that the outcome of spinal surgery could be predicted based on whether a client had suffered any of five possible traumatic situations in their childhood. These included: physical abuse, sexual abuse, emotional neglect/abandonment, loss of one or both parents (divorce, death, etc.), drug abuse at home (alcohol, prescription drugs, etc.). As indicated in this reference, “The result of surgery and postoperative pain have little to do with the surgical procedure itself but largely depend on factors that date back to the childhood of the patient.”
There are many research articles and reference books on the subject of pain and its neurophysiology. This type of information gives the clinician a more scientific approach to understanding the cause and effect of acute and chronic pain. It may also allow us to venture into another scope of practice besides treating an orthopaedic or neurological diagnosis while still focusing on a client’s function.
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