Episode 88 - Tamar Pincus: Psychology and Back Pain

Tamar Pincus PhD

Professor Tamar Pincus holds a PhD (University College London), as well as Masters degrees in experimental research methods in psychology (UCL), and epidemiology (Cambridge University). Her research has embraced a variety of methodologies, including experimental, epidemiological and qualitative. The research has included investigation of attention and recall in pain patients; the psychological predictors for poor outcome in low back pain, and the study of clinicians’ beliefs and attitudes in low back pain. Recently the focus of her research has moved to investigating the effectiveness of interventions through randomised controlled trials, and throughout she has collaborated closely with researchers from many disciplines, including doctors, physiotherapists, osteopaths, chiropractors and clinical psychologists, from a multitude of institutions, from around the world. She also convened the international consensus group to establish what factors and measures should be included in prospective cohorts investigation the transition from early to persistent back pain. Most recently her research has focused on delivering effective reassurance to patients in primary care.

 

Professor Pincus is very interested in learning how her research impacts clinicians and to what extent her research is practically applied.  She would like your feedback through completing a ver brief survey.  For your trouble I'll send you a full text copy of her study, Psychological factors and treatment opportunities in low back pain.  

Upon completing the survey, sign up for my newsletter.  There you'll receive a copy of her paper as a thanks, for your help!

 

 

 

Show Notes

 

Personal Background

Professor Pincus shares a bit about her family and their love for music

 

Professional Background

Tamar takes us through her journey which began after her first degree which was in music.  She was influenced by Pat Wall, of Melzack and Wall, who wrote the Gate control Theory of Pain.  She speaks of his influence on and inspiration to her.  She explains her strength is in her research methods due to the education she’s had and from those that she’s trained under.

 

You have an opportunity to participate in a survey as Tamar is interested to study the impact of her research on clinicians and to learn of any impact it’s had on clinical thinking and patient outcomes.

 

AFTER you've listened to the interview, you can participate in this very brief survey here.

 

Remember, by completing this survey and signing up for my newsletter I'll send you a link to the full study of her recommended study.

 

Quote

 

“Nobody can stand truth if it is told to him. Truth can be discovered only, if you discover it yourself.  Because then, the pride of discovery makes the truth palatable.”

        ~ Fritz Perls

 

She believes this is important in working with patients who are dealing with musculoskeletal pain and who are coping with it in various ways.

 

Does simply correcting the mechanical problem clear up the psychological issues?

Tamar describes how she has heard others propose that resolving the organic musculoskeletal problem makes the psychological issues go away.  She doesn't find that this is the case in most situations and elaborates a bit further.

 

How Do We Identify if the psychology issues are primary or secondary to the mechanical factors?

Tamar reminds us, “there is no pain without psychology.”  She goes on to clarify how psychology and the pain experience interact.  Depression and distress are, in her view, normal and she believes should not necessarily be medicalized. She gives the three primary findings related to psychology related to, for instance, low back pain which predict poor outcomes.

Memorable Patient Story

Tamar offers a typical response from patients, what she calls three strikes that the patient might give and that we might miss if we’re not careful.  She goes on to describe the value of open versus closed questions and the surprising

 

Belief that we should be happy, successful, pain-free

Professor Pincus explains how the belief that we should always feel happy, successful, beautiful and pain-free is dysfunctional and can influence frustration and disappointment, not just with patients but with all people.  She shares another quote that relates.

“You cannot achieve happiness.  Happiness happens and it is a transitory state. Imagine how long I got happiness when I got relief from bladder pressure.  How long did that happiness last?”

        ~ Frits Perls

 

Patient Education Analogy

Tamar gives an analogy, describing the same event but happening within two separate contexts or in very different scenarios and how an individual might react so differently to that event dependent on what’s happening at that time and in what state of mind the individual is in at that moment.

She also shares an analogy given by Acceptance and Commitment Therapy. She describes two ways in which people engage with pain that are not helpful.  She explains how over-focusing on and overly ignoring pain are both unhealthy approaches.

She further, warns a typical physio/physical therapist that in some situations patients need to be referred on for a psychological evaluation.  She also shares some potential cues that might help us identify those that need to be referred on.

 

Therapeutic Alliance

Professor Pincus speaks on an area here that she’s passionate about.  She talks about implicit and explicit reassurance that is important to include in your patient interactions.  Education to the patient, she explains, of the causes, prognosis, treatment and other alternatives that exist and then exploring their view of that education is very impactful on the true outcome.   

 

Psychology Measurement Tools

Tamar mentions some tools that can help, specifically the STarT tool.  But she also mentions embedding an informal questioning and some hints how to make that process most helpful.

 

Resources Wouldn’t Do Without

Tamar would encourage anyone working with patients who have chronic pain and, really, any type or duration of pain to this book.  She believes its a good summary of these issues.

Pain Management: Practical Applications of the Biopsychosocial Perspective in Clinical and Occupational Settings. by Chris Main

 

 

Scientific Studies She’d Recommend

Psychological factors and treatment opportunities in low back pain. Pincus T, McCracken LM. Best Pract Res Clin Rheumatol. 2013 Oct;27(5):625-35.

 

Best Advice

Tamar offers three main principles to remember practically in the clinic and gives this final quote.

It’s also from Fritz Perls

“I do my thing and you do your thing.  I am not in this world to live up to your expectations, and you are not in this world to live up to mine.  You are you and I am I and if by chance we we find each other, it’s beautiful. If not, it can’t be helped.”