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- Caneiro, J. P., et al.
(author)
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From Fear to Safety : A Roadmap to Recovery from Musculoskeletal Pain
- 2022
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In: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 102:2
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Journal article (peer-reviewed)abstract
- Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening, and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain, as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing cognitive functional therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
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| 2. |
- Caneiro, J. P., et al.
(author)
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How does change unfold? an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy : A replicated single-case experimental design study
- 2019
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In: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 117, s. 28-39
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Journal article (peer-reviewed)abstract
- PURPOSE: To understand the process of change at an individual level, this study used a single-case experimental design to evaluate how change in potential mediators related to change in disability over time, during an exposure-based behavioural intervention in four people with chronic low back pain and high pain-related fear. A second aim was to evaluate whether the change (sequential or simultaneous) in mediators and disability occurred at the same timepoint for all individuals.RESULTS: For all participants, visual and statistical analyses indicated that changes in disability and proposed mediators were clearly related to the commencement of Cognitive Functional Therapy. This was supported by standard outcome assessments at pre-post timepoints. Cross-lag correlation analysis determined that, for all participants, most of the proposed mediators (pain intensity, pain controllability, and fear) were most strongly associated with disability at lag zero, suggesting that mediators changed concomitantly and not before disability. Importantly, these changes occurred at different rates and patterns for different individuals, highlighting the individual temporal variability of change.CONCLUSION: This study demonstrated the interplay of factors associated with treatment response, highlighting 'how change unfolded' uniquely for each individual. The findings that factors underpinning treatment response and the outcome changed simultaneously, challenge the traditional understanding of therapeutic change.
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