The Multidimensional Factors to Address in Persistent Pain

Kjartan starts with ruling out serious pathology such as cancer, infection or systemic disease, noting that imaging is useful here and that red flags are not always straightforward to detect. On the physical side, he looks at how much people move, whether they cope actively or passively, sustained postures and habitual patterns such as not using the legs when bending or lifting, while noting that some people are endurance copers. Psychosocial factors include stress, anxiety, fear of hurting the back and sleep, where a simple sleep diary is a useful tool. Bladder and bowel problems are often overlooked. Social factors deserve far more weight: many patients lose work, sport and social contact and describe life on hold. Pain mechanisms and genetics also inform explanations. No clinician can grasp a person's whole situation in an hour or two, so the aim is to make sense of pain together and form an individualized, person-centered plan that builds self-efficacy rather than dependence.