Psychological factors related to musculoskeletal pain. Clinical implications for physiotherapists

Introduction: Persistent musculoskeletal pain is the most common pain condition seen in primary health care in Western European countries. The psychological aspects of such long-term pain are emphasized by several authors. Main section: Catastrophizing, pain beliefs, self-efficacy, fear-avoidance and mindfulness are associated with development and maintenance of pain. These factors as well as signs of sensitization need to be recognized by physiotherapists treating patients with long-term pain. Elements from cognitive-behaviour perspectives and mindfulness-based methods might be appropriate to implement in the treatment approach. The patient-therapist communication is essential both as an examination tool and as an integrated part of the treatment. Adequate choice and grading of traditional physiotherapy such as exercise therapy is also decisive for success in treating patients with persistent musculoskeletal pain. Conclusion: In the examination and treatment of patients with long-term pain, the physiotherapists need to acknowledge the several components of pain; the biological, cognitive, affective and social. These factors together constitute the basis for choosing treatment approaches and treatment dose