Psychosocial Perspectives of Health and Illness

CASE STUDY DYNAMICS- IDENTIFICATION OF KEY ISSUES

Ellen, who is married for nine years and of 40 years of age, sustained a severe neck injury in a motor vehicle accident. Being a qualified architect, she supported the family financially until her injury which made her suffer severe pain. It was observed that being a mother of an eight year old daughter, Ellen’s accident has not only affected her but also her family. As the whiplash would have affected their physical ability adversely, she would not have been able to full her responsibilities and duties towards her husband and daughter as she was doing before. Observations suggest that for one year, she may have been assisted by her husband and others in the family to such as extent which made her over- dependent on them. Further, observations indicate that perhaps she is too tired and upset regarding the neuropathic pain which seems to be difficult to manage thus adding to her dependence on others. Though Ellen has made efforts to try a number of medications so that she to return back to her normal life but these have not provided considerable relief to her. Hence, it can be observed that the client wants to recover and take up her responsibilities but the pain is acting as a barrier in doing so.

Further, the family is suffering from financial issues as Ellen is unable to take up her role as the bread winner. Hence, it can be interpreted that she is struggling to support her husband in financial problems that family is going through. This could have affected her husband as well as he not only has the responsibility of taking care of Ellen but also to bring income to the family. Observations made indicate that all these problems have made Ellen feel very low and experience sleeping problems. Most important observation made was that she is upset about failure to fulfil the responsibilities as a mother as she is no longer able to accompany her daughter in various school and social activities. This has reduced the time that Ellen spent with her daughter. Another important observation in Ellen’s case was lack of affection in the relationship with her husband.

Issues

Following are some of the major issues that have been identified in Ellen’s case

• Being a married woman, Ellen has psychosocial need of obtaining affection from her husband. However, her husband seems distracted which has been identified as an issue in the case.
• Another psychosocial need of Ellen is regarding mental health and belongingness. However, the issue is that as she is incapable of accompanying her daughter, hence, this need is being unattended. There is lack of interaction among the client and family members. Further, the anxiousness about supporting the family financially is affecting Ellen’s mental health as it is acting as a burden on her.
• Lack of support and burden of financial problems has led to issues of mental health in Ellen such as sad mood and sleeping disorders.
• Social, cultural and ethnic identity needs are associated cultural and ethnic environment of the client. In the present case, Ellen is not able to return to work properly which suggests that the illness has affected her job status.
• Non-treatable neuropathic pain is another issue identified in the case that may be affecting the client adversely.
• Overdependence on family members is another issue identified in Ellen’s case.

EXPERT OPINION- ANALYSIS OF ISSUES

Ellen suffers from incurable neuropathic pain. She has made efforts and taken a number of different medications but these have not relieved her pain. According to Pain Management Health Center (2016), whiplash may damage several intervertebral joints, ligaments, discs, ligaments, cervical muscles. This results in pain in neck, shoulder, lower back and arm. North American Spine Society assert that only one out of three patients are such who could not completely recover from whiplash. However, in those patients also, the pain is not severe enough to interfere with daily activities. 10 per cent of people are those who suffer from severe neck pain after suffering a whiplash due to a motor vehicle accident. These are the patients for whom considerable medical care is required. If the pain lasts longer, it may be due to injury to the disc or facet joint. Considering the symptoms of whiplash, it was found that the pain may cause sleep problems. Hence, it can be analysed that Ellen’s sleep disorders may be caused due to the severe chronic pain that she is suffering from. Further, North American Spine Society also found that there is no best medicine for neck pain.

Central Physical therapy and Fitness (2015) state that the source of chronic neck pain after whiplash is not known. This is because there are a number of possibilities within the neck structures that may be a cause of chronic pain. Continued pain may occur as a result of tiny fractures or tears of the surface of joints.

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Daniel J. DeNoon, (2016) who is a senior medical writer for WebMD claimed that one in 10 patients who suffer whiplash are such that they have long lasting pain. DeNoon further stresses that the severity of this pain is to such as extant that the patient is unable to do daily works of a normal lifestyle. According to neurologist Henry Berry, MD of University of Toronto, there are a number of aspects associated with chronic whiplash syndrome. These factors are associated with the state of mind of the person. It can be analysed that as per the case, Ellen was stressed due to a number of reasons. These included her inability to support her family financially, being unable to fulfil her responsibilities as a mother etc. All these reasons may have affected her state of mind, thus adding to the problem of chronic pain.

Another issue faced by Ellen is that her psychosocial needs related to love and belongingness are being unmet. Her husband is distracted and demonstrates lack of affection towards Ellen. He also seems to be distant and there is lack of interaction among the family members. As Ellen is not able to lead a normal life due to being unable to fulfil her responsibilities, her psychosocial needs associated with love and belongingness may not be satisfied adequately. This is because there is burden of additional responsibilities on her husband and daughter due to which the gap among the family members has widened. Carstensen (2012) stressed that human are social animals and hence lack of it can lead to profound adverse consequences. Whiplash can sometimes lead to persistent pain and disability in some patients.

According to Nyström and et.al., (2016), certain psychosocial factors are associated with delayed recovery after whiplash. These include passive coping, job dissatisfaction or fear. Bio- psychosocial model states that pain should be viewed in terms of a combined effect of various factors which may be physical, environmental and psychological. There is continuous interaction of these factors with one another. This interaction impacts the recovery of patient and the status of his pain. Pain may be caused due to physical factors initially however, with time, these factors assume less importance. This is because psychosocial factor come to play an important role in such situations. According to bio – psychosocial model, motor vehicle collision is entered by a person with previous life experiences, lifestyle, and illness behaviour. These may act as vulnerability factors and can interact with physical, psychological and social factors.

Moreover, the prevalence of chronic pain after whiplash is significantly dependent on the psychosocial factors. In this regard, it can be analysed that the problem of persistent neuropathic pain in Ellen may be due to unmet psychosocial needs. This may also be interfering with her recovery. This suggest that these factors are responsible for persistent pain behaviour in whiplash patients. There is a strong relationship between emotions such as depression and pain and disability. It can be analysed that these can be reason behind the issue of over dependence of Ellen on the family members. Depression and other psychosocial factors such as fear of pain may have made her perceive herself to be disabled to perform the daily activities of life even aft6er one year of accident. This has increased her dependence on the other family members. She would be suffering from fear of pain from taking the normal routine. Further, these may be considered as reasons that predicted the persistence of pain and disability over long time. Psychology aspects of work such as poor job satisfaction may also be related to pain.

Furthermore, according to American Family Physician, there are various psychosocial symptoms associated with whiplash injury. These are depression, anxiety, family stress, occupational stress etc. If the patients are treated as malingerers, then these symptoms may be aggravated. These may delay the relief of suffering. This is similar to the issue identified in Ellen’s case. She was suffering from various psychosocial problems such as family stress. It was being difficult for her to handle her responsibilities related to job and family. As a result of these problems, it may be possible that despite taking medications, she was not relieved from neuropathic pain. Ellen was no longer able to support her family in financial terms. This may have made her feel inferior and guilty. Further, her husband was not receiving any financial support from her end unlike before. Apart from that, he also had to take additional duties as Ellen was not able to perform them. This would have made her husband become distracted, over - burdened and stressed. As a result of this, Ellen would have felt that she has lost the social status that she earlier possessed in the family. These feelings would have aggravated her perception of vulnerability. Further, physically she was unable to undertake the activities with the same pace as before. A combination of these factors would have made her feel frustrated and depressed, thus aggravating the perception of persistent pain. Ellen would also have been concerned about her job status as she was no longer able to work as an architect. Moreover, the issue suggests that she would be feeling dissatisfied being unable to play social role as before which was eventually taken up by her husband. This emotional turmoil would be the reason behind delayed recovery and perception of disability.

It was also found that Ellen was not receiving support of any kind from her husband or others around her. Her only time for interaction with her daughter was when she accompanied her for school and social activities. But, as physically she could not be able to do so, it would have aggravated the issue of unmet psychosocial needs. The biomedical model focused on the dualistic view of mind and body that existed within the health care system. This model implicated that the mind and body work independently. It focused on identification of causes of a disease and their correlation with anatomic changes. The intra or interpersonal factors were not considered by this model. Considering this model, it can be analysed that psychosocial factors are not responsible for Ellen’s persistent pain and disability.

CONCLUSION

Analysing the issues identified in Ellen’s case, it can be concluded that chronic pain and disability in whiplash is associated with a number of physical, environmental and psychosocial factors. Whiplash patients suffer from a number of problems such as tightness in the neck, decreased range of motion and pain in the neck and head. They also suffer from headaches at the base of skull. Apart from that, psychosocial problems such as depression, anxiety, frustration etc. are also faced by them. All these make the patient’s unable to carry out the daily activities of life. This increases their dependence on the other family members. Moreover, they are not able to take social roles as before which in turn can be considered as a cause for depression. Moreover, in some patients, the symptoms of whiplash last longer as compared to others. These may be due to physical or psychosocial factors. Physical factors may include damage to a number of structures which may have been disrupted or injured during whiplash. These includes facet joints, disks, muscles and tendons in neck. Surface damage or tears in muscles are the reasons behind chronic pain. Sometimes the pain is severe and may significantly interfere with the normal routine of a person. It may restrict them from making movements and taking up the tasks which comprise the daily work of an individual. However, sometimes, chronic pain after suffering a whiplash may be due to psychosocial factors. These significantly impact the perception of a patient regarding persistent pain and disability. The various psychosocial factors may include fear, psychological distress, depression etc.

Similar problems and issues were identified ion Ellen’s case. She was suffering from various psychological problems such as sad mood and sleeping disorders. Further, there was chronic neuropathic pain that troubled Ellen. She was also not receiving proper support from the family. Moreover, as she was unable to support the family, she was stressed about the financial condition and other responsibilities. It can be concluded that all these factors may have aggravated the perception of pain and disability due to which she was suffering from chronic pain and was being over dependent on the family members even after 1 year of accident. It can also be concluded that the psychosocial needs of Ellen associated with love and belongingness were not being met. Moreover, there was lack of interaction in the family members which could have made Ellen feel depressed.

It can be inferred that family and carers play a significant role in the patient’s recovery after a traumatic injury like whiplash. After such an injury, the patient’s recovery is impacted by his previous experiences regarding illness and his perception towards health. Whiplash renders a person unable to carry out daily activities due to pain and stiffness and other symptoms such as nausea. However, it is important that in order to manage these issues, the family members and carers provide adequate support to the patients.

In this regard, the following implications arise for the practice of managing whiplash:

• Efforts should be made to interact with the patient and identify his or her psychosocial needs. Following this, steps should be taken for fulfilling the needs associated with love and belonging. Proper support should be provided to the patient so that he may develop a positive perception towards recovery.
• Dependence of patient should be managed by encouraging him to undertake the daily activities of life and by demonstrating confidence in the patient.
• Alternative therapies should be undertaken in case of chronic pain post whiplash.

RECOMMENDATIONS

Following are the recommendations for Ellen

Spinal manipulative therapy

As Ellen is suffering from chronic pain, spinal manipulative therapy (SMT) is recommended for her. this therapy is provided by specially trained psychical therapists, osteopaths or chiropractors. This recommendation is justified as Ellen’s pain is not being cured through medication and SMT will help in providing her relief in a safe manner. Moreover, it would be better to combine SMT with instructions for strength training and body mechanics instruction.

Strength training

Strength training is also recommended for Ellen as it will help in developing sufficient muscle strength. As a result of this, she will be able to hold the neck and head in right positions during rest as well as while performing an activity. This strength will provide Ellen with the confidence of undertaking their activities of her daily life. This recommendation is justified as it will help in reducing her dependence on other family members. Range of motion will be improved by strengthening the muscles.

Sessions with health professional

Rehabilitation of Ellen would involve sessions with a qualified health professional so that other psychosocial factors that impact her recovery could be managed. These include depression, trauma related anxiety etc.

Supportive attitude

The family member, specifically Ellen’s Husband, is recommended to be supportive in managing post – traumatic stress that she is suffering from. He should provide adequate social support to Ellen as it will play an important role in Ellen’s recovery. Hence, recommendation is provided for strengthening social relationships.

Radiofrequency treatment

This is another treatment that can be recommended to Ellen. It assumes that pain can be eliminated by focusing on the blocking of nerve signals to the joint. Radiofrequency is a considered to be a neurosurgical procedure where radio waves are directed at nerve branches. Enough heat is created whichdestroys the nerve endings. This is recommended as it provides long lasting relief from pain that Ellen was suffering from.

Observing patience during treatment

Lastly, Ellen can be recommended to be patient and positive about her health. This is because perception about a particular illness can have a significant influence on the recovery.

REFERENCES

• Angst, F. & et.al., (2014). Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study. BMC musculoskeletal disorders.
• Carstensen, T. B., (2012). The influence of psychosocial factors on recovery following acute whiplash trauma. Dan Med J.
• Chiarotto, A., Fortunato, S., & Falla, D. (2015). Predictors of outcome following a short multimodal rehabilitation program for patients with whiplash associated disorders. European journal of physical and rehabilitation medicine.
• Nyström, B. & et.al., (2016). A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: Fusion surgery was superior to multimodal rehabilitation in a randomized trial. Scandinavian Journal of Pain.
• Scott, W. & et.al., (2015). Barriers to change in depressive symptoms after multidisciplinary rehabilitation for whiplash: The role of perceived injustice. The Clinical journal of pain.
• Scott, W., Wideman, T. H., & Sullivan, M. J. (2014). Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: a prospective study of individuals with subacute pain after whiplash injury. The Clinical journal of pain.
• Skillgate, E. & et.al., (2016). Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study.Archives of physical medicine and rehabilitation.
• Van der Meer, S. & et.al., (2016). How does injury compensation affect health and disability in patients with complaints of whiplash? A qualitative study among rehabilitation experts-professionals. Disability and rehabilitation.
• Yakobov, E. & et.al., (2016). Treatment-Related Reductions in Disability Are Associated with Reductions in Perceived Injustice Following Treatment of Whiplash Injury. Psychological Injury and Law.