Flags

Question 1

Red Flag

Answer 1

Signs of serious pathology

Ex:	Cauda equina syndrome,
 fracture, 
tumour, 
unremitting night pain,
 sudden weight loss of 10pounds over 3 months, 
bladder & bowel incontinence,
 previous history of cancer, 
saddle anaesthesia,

Question 2

Orange Flag

Answer 2

Psychiatric symptoms

Clinical depression, personality disorder

Question 3

Yellow Flag

Answer 3

Beliefs, appraisals and judgements -

1. Unhelpful beliefs about pain: indication of injury as uncontrollable or likely to worsen.
2. Expectations of poor treatment outcome, delayed return to work.

Emotional Responses-

1.Distress not meeting criteria for diagnosis of mental disorder.
Worry, fears, anxiety.
Pain behaviour (including pain and coping strategies) Avoidance of activities due to expectations of pain and possible reinjury.
Over-reliance on passive treatments

Examples
Catastrophising – thinking the worst
Finding painful experiences unbearable, reporting extreme pain disproportionate to the condition

Having unhelpful beliefs about pain and work – for instance, ‘if I go back to work my pain will get worse’

Becoming preoccupied with health, over-anxious, distressed and low in mood

Fear of movement and of re-injury

Uncertainty about what the future holds

Changes in behaviour or recurring behaviour
s
Expecting other people or interventions to solve the problems (being passive in the process) and serial visits to various practitioners for help with no improvement..

Question 4

Blue Flag

Answer 4

Perceptions about the relationship between work and health

Belief that work is too onerous and likely to cause further injury.

Belief that workplace supervisor and workmates are unsupportive.

Question 5

Black Flag

Answer 5

System or contextual obstacles

Legislation restricting options for return to work. Conflict with insurance staff over injury claim.

Overly solicitous family and health care providers.

Heavy work, with little opportunity to modify duties.

Question 6

What is Catastrophisation?

Answer 6

The first of these is making a catastrophe out of a situation. For instance, if you’re a salesperson and haven’t made a sale in awhile, you may believe you are a complete and utter failure and you will lose your job. In reality, it may only be a temporary situation, and there are things that you can do to change this situation. Another example is believing that if you make one small mistake at your job, you may get fired. This kind of
catastrophizing takes a current situation and gives it a truly negative “spin.”

The second kind of catastrophizing is closely linked to the first, but it is more mental and more future oriented. This kind of catastrophizing occurs when we look to the future and anticipate all the things that are going to go wrong. We then create a reality around those thoughts (e.g. “It’s bound to all go wrong for me…”). Because we believe something will go wrong, we make it go wrong.

Both types may lead you to self-pity, to an irrational, negative belief about the situation, and to a feeling of hopelessness about your future prospects. Further, both of these types of catastrophizing will define either the presence or absence of alternative possibilities, and possibly paralyze you from going further with efforts toward your goals in life.

Question 7

How does stress affect pain?

Answer 7

Stress modulates pain perception, resulting in either stress-induced analgesia

or stress-induced hyperalgesia,

The responses to stress include neural, endocrine, and behavioural changes, and built-in coping strategies are in place to address stressors.

Peculiar to humans are additional factors that modulate pain that are experienced in times of stress, notably psychological factors that potentially influence the directionality of pain perception.

A negatively valenced emotion with low to moderate arousal evokes anxiety and enhances pain

Animal studies have shown that oestrogen enhances pain sensitivity

Amount of pain perceived by a person is governed not only by the amount of tissue injury present but also by emotional and psychological factors.

Question 8

Effects of prolonged stress?

Answer 8

Chronic stress has been shown to attenuate dopaminergic activity in the nucleus accumbens, resulting in hyperalgesia

Other findings show that prolonged stress causes dysfunction of the HPA axis, causing metabolic derangement that subsequently leads to obesity and other metabolic syndromes, such as Type 2 diabetes and atherosclerosis

One study showed that Chronic stress also caused decreased morphine sensitivity, suggesting that the opioidergic systems were modified