School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; Body Logic Physiotherapy, Perth, Australia.
Department Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Braz J Phys Ther. 2021 Jan-Feb;25(1):17-29. doi: 10.1016/j.bjpt.2020.06.003. Epub 2020 Jun 20.
Beliefs about the body and pain play a powerful role in behavioural and emotional responses to musculoskeletal pain. What a person believes and how they respond to their musculoskeletal pain can influence how disabled they will be by pain. Importantly, beliefs are modifiable and are therefore considered an important target for the treatment of pain-related disability. Clinical guidelines recommend addressing unhelpful beliefs as the first line of treatment in all patients presenting with musculoskeletal pain. However, many clinicians hold unhelpful beliefs themselves; while others feel ill-equipped to explore and target the beliefs driving unhelpful responses to pain. As a result, clinicians may reinforce unhelpful beliefs, behaviours and resultant disability among the patients they treat.
To assist clinicians, in Part 1 of this paper we discuss what beliefs are; how they are formed; the impact they can have on a person's behaviour, emotional responses and outcomes of musculoskeletal pain. In Part 2, we discuss how we can address beliefs in clinical practice. A clinical case is used to illustrate the critical role that beliefs can have on a person's journey from pain and disability to recovery.
We encourage clinicians to exercise self-reflection to explore their own beliefs and better understand their biases, which may influence their management of patients with musculoskeletal pain. We suggest actions that may benefit their practice, and we propose key principles to guide a process of behavioural change.
人们对身体和疼痛的信念在对肌肉骨骼疼痛的行为和情绪反应中起着强大的作用。一个人所相信的以及他们对肌肉骨骼疼痛的反应方式会影响他们因疼痛而致残的程度。重要的是，信念是可以改变的，因此被认为是治疗与疼痛相关残疾的重要目标。临床指南建议，在所有出现肌肉骨骼疼痛的患者中，将纠正不良信念作为一线治疗方法。然而，许多临床医生本身就持有不良信念；而其他临床医生则觉得自己没有能力去探索和针对导致对疼痛的不良反应的信念。因此，临床医生可能会在他们治疗的患者中强化不良信念、行为和由此产生的残疾。
为了帮助临床医生，在本文的第 1 部分，我们讨论了信念是什么；它们是如何形成的；它们对一个人的行为、情绪反应和肌肉骨骼疼痛结果的影响。在第 2 部分，我们讨论了如何在临床实践中处理信念。通过一个临床案例来说明信念在一个人从疼痛和残疾到康复的过程中可能起到的关键作用。
我们鼓励临床医生进行自我反思，以探索自己的信念，并更好地理解自己的偏见，这些偏见可能会影响他们对肌肉骨骼疼痛患者的管理。我们提出了一些可能对他们的实践有益的行动，并提出了指导行为改变过程的关键原则。
