CBT for Kinesiophobia

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CBT for lumbar spine surgery

What is Kinesiophobia?

Sufferers of Kinesiophobia are afraid of movement, as they believe it will cause or increase the sensations of pain they are experiencing or have previously experienced. Those most at risk of the condition are patients who have suffered intense pain, often for a significant length of time, and have therefore become accustomed to suffering some degree of pain almost constantly.

Kinesiophobia causes problems for patients who are undergoing physiotherapy following surgery or illness. They are reluctant to commit to completing the exercises required to assist them in their recovery, as they fear that the movement required by the exercises will cause them increased levels of pain. This results in them making a far less effective recovery and perhaps suffering increased problems in the future.

Pain

Pain can be defined as the body’s reaction to a harmful stimulus. It can originate from different areas of the body at once and in differing degrees. Patients suffering from pain which goes untreated because they refuse the recommended physiotherapy, concerned it will lead to further pain, can experience more serious problems in the future. Kinesiophobia sufferers are at an extremely high risk of this.

Pain alters the brain, and if it is continually suffered with no abatement it can change the body’s reactions and cause patients to feel ‘pain’ where there previously was none. That is to say the sufferer feels as though sensations which were previously harmless are now painful, or they misinterpret painless sensations as though they cause hurt. At this point the body’s central nervous system begins to change and a cycle of immobility begins, which causes the levels of pain to increase with no end in sight for the sufferer.

Cognitive Behavioural-based Physical Therapy

A recent study looked at the effects of Cognitive-Behavioural based Physical Therapy (CBPT) on patients who were undergoing lumbar spine surgery and therefore experiencing chronic pain as a result of the operation. The study focused on 86 adults who were experiencing back problems and required surgery to remove some part of their vertebra. It aimed to look at the recovery of such patients and the potentially positive effect of CBPT on the outcome of their operation and recovery.

Patients were tested prior to surgery using the Tampa scale, to determine how high their fear of pain was, or how badly they suffered from kinesiophobia. Six weeks post-surgery, patients were referred to either CBPT or an Education programme, and the results were measured. Patients were assessed pre-treatment, post-treatment and at a follow up appointment three months later. Assessment took the form of measuring levels of pain and disability experienced by the patients, as well as considering their general health and their performance in tests such as walking for 10 metres or standing from a seated position.

Results at the three month follow up appointment suggested that those patients on the CBPT programme had lower levels of pain and disability. They also had increased physical ability in the performance tests, and their general health was better than those patients on the Education programme.

General conclusions of the study suggest that CBPT is likely to reduce levels of pain and increase patients’ mobility more rapidly than current Education and physical therapy programmes. Future use of CBPT as part of the physical therapy programme following major spinal surgery may also help to address those patients at risk of suffering from psychosocial issues as a result of pain caused by surgery. Incorporating elements of CBPT into physical therapy programmes for those undergoing spinal surgery is therefore considered to be of great benefit, particularly for those patients at a higher risk of poor recovery.

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