Two articles published in The Spine Journal this month reveal new information about how psychological factors can increase recovery times and delay return to work. Researchers primarily from the University of Zurich reviewed the current literature and found that there are two primary factors related to poorer injury outcomes: catastrophizing and fear-avoidance beliefs. Catastrophizing is behavior that dramatizes pain to the extent that the patient perceives their problems as significantly worse than they are, whereas fear-avoidance beliefs are structured around the patient’s fear of increased pain and subsequent avoidance of activity. This avoidance can lead to additional issues such as deconditioning of the musculature. It is worth noting that these conclusions are with respect to lower back injuries, not all injuries. Some large companies have instituted psychological checkpoints for chronic pain injuries in order to catch these issues before they become severe. Further, the American Chronic Pain Association’s resource guide recommends cognitive behavioral therapy, an evidence-based form of therapy.
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