Fear-Avoidance / Chronic Pain

Case Description: Pt. had multi-level surgical fusion ~1 year prior and had been on bed rest (in a cervical brace) up until ~1 month before therapy started due to complications during her recovery, including cardiac issues. She showed signs of catastrophizing despite all medical red flags being ruled out by her surgeon, her primary care, and lastly a thorough PT evaluation. She was firmly entrenched in the left side of the below diagram, well on her way to a life of disability and chronic pain.  Patient was seen for 11 physical therapy visits over a 2 month period.

	Initial Evaluation	Day of Discharge
VAS for Pain	3-6/10	2/10
Neck Disability Index	50% disability	18% disability
Language related to her neck pain and arm pain	“I’m going to be paralyzed” “My arteries are going to explode” “My head weighs a thousand pounds” “If I move it, it is going to break”  “My neck is ripping/stabbing”	“Sore but safe.” “I know movement is good for me.” “When I move it, it will feel better.” “I’m OK, I just need to take breaks and pace myself.”

Patient Comments at Discharge: “Great communication of what they are doing and the benefits.  Cozy environment that lends itself to healing in a comfortable place…I have learned to increase my mobility in moving my neck with less pain.”