Yellow flags the impact of psych

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					Yellow flags: the impact of
psychosocial factors in low
back pain.
Richard Brown DC, LLM, FCC, FBCA, FEAC
PRIVATE PRACTICE, GLOUCESTERSHIRE, UK
Chiropractic management in the
presence of psychosocial factors
 Presence of psychosocial factors require a
  shift in the focus of care.
 As primary healthcare professionals we
  need to be aware of behavioural
  management techniques.
 Aim is always to reduce long term disability.
13 STEPS TO EARLY BEHAVIOURAL
     MANAGEMENT OF LBP
1. Provide positive expectations
2. Review regularly and keep focus on
function, not pain.
3. Keep patients active and at work
4. Acknowledge ADL difficulty but
don’t encourage avoidance.
5. Help maintain positive
collaboration between employer and
employee. Avoid ‘them and us’.
6. Discourage time off work.
7. Be alert to negative beliefs
8. Promote self-management
9. Be prepared to ask for a second
opinion
10 Don’t confuse report of symptoms
with emotional distress.
11. Avoid suggesting job change
12. Pain is controllable
13. Consider multidisciplinary team
Under-identifying psychosocial factors
  Consequences:
   Reinforces factors that are disabling
   May result in harmful effects of prolonged
    inactivity.
   Withdrawal from social, vocational and
    recreational activities
   Physiological consequences (muscle wasting)
   Chronicity
Over-identifying psychosocial factors

Consequences:
 Too much focus on the psychological away from the
  physical
 May cause the patient to question whether their pain is
  real
 Under-diagnosis of serious pathology.
Pain behaviour v Malingering
Malingering is the intentional production of
false or grossly exaggerated symptoms,
motivated by obvious external gain.

Pain behaviour is part of the normal
experience of pain. It is influenced by
upbringing, culture and circumstances at the
time.
Risk Management
Duty to be vigilant
Patients can be dangerous
Beware of hazards
Who complains?
Patients can be unpredictable…
Patients can be unpredictable…
Depressive disorder
Tinted glasses!
Backward sloping writing
Green ink
Wrist splints
Lots of cats
Detailed typewritten summaries
Serial complainants
Self preservation
Meticulous note taking
Active listening
Build relationships
Be interested

				
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