Considering the Stress Pain Cycle in Assessment

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Introduction

Physiotherapists are trained professionals who, on a daily basis, help clients deal with pain and movement dysfunction.  As the profession has moved towards evidence based practice the way a client's therapy is delivered has also changed, we are moving away from didactic teaching and anecdotal practices, to provide the client with interventions that are based not only our clinical experiences but solid research.   This has led to to changing from the biomedical based approach to a more client centred biopsychosocial approach.  This has been largely influenced by the recognition that emotional factors such as fear, anxiety and stress can delay and impede the recovery of those suffering from pain.  Fear and anxiety may be personality traits but they can also be a byproduct of stress and stress has now been recognised as a factor in pain.  It is well known that short term stress can be beneficial, especially in a crisis, but persistent or long term (chronic stress) can be the cause of pain.  It has also been determined that stress can be one of the symptoms of chronic pain.  In order to fully understand the shift in assessment and treatment approaches it is important to understand stress and also how people’s behaviour and fears affects not only their pain but also their perception and approach to pain and participation recovery. 

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