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Table 5 Listing of observable pain behaviors found in the systematic search and review

From: How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review

 

Does the patient exhibit this PB?

If yes, with the integration of the patient’s context, beliefs, the frequency of this PB, etc., the clinician can interpret if the PB is adaptive or not and interferes with the rehabilitation process

Verbal and nonverbal communication

Pain-related behaviors that can be verbalized or executed by the patient to communicate with the therapist about his/her pain

 • The patient stays focused on pain communication (e.g., always refers to his/her pain during conversation) [28, 29, 35, 41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56]

 

 • The patient stays focused on disability or impairments despite clinical improvements [43, 52, 54, 57,58,59,60]

 

 • The patient verbalizes hesitation or questions about his/her capacity to perform feasible tasks [42, 54, 55, 58, 61]

 

 • The patient asks for help for tasks he/she can perform independently (alone) [27, 44,45,46, 49, 55, 60, 62,63,64,65]

 

Touching/rubbing the painful area after task accomplishment [11, 18, 28, 29, 31,32,33,34,35,36, 39, 42, 45, 51,52,53,54,55,56, 58, 61, 66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111]

 

Sounds

Pain-related behaviors that can be heard by the therapist when the patient performs tasks or activities

 • Groaning, Moaning, Whining, Whimpering, Crying, Screaming

[11, 18, 27,28,29,30, 34, 35, 37, 39, 42, 44,45,46,47, 49,50,51, 53,54,55,56,57,58,59, 61,62,63, 67, 68, 70,71,72,73,74, 88, 97, 103,104,105, 107, 109, 111,112,113,114]

 

Sighing, Holding their breath, Taking a deep breath [11, 18, 27,28,29,30,31,32,33,34,35,36, 39, 42, 44, 50, 53,54,55,56,57, 61, 66, 68, 69, 71,72,73,74, 76,77,78,79,80,81,82, 85,86,87, 89,90,91,92,93,94, 96, 97, 100,101,102,103, 106, 107, 109,110,111, 115, 116]

 

Posture and movements

Pain-related behaviors that can be seen by the therapist when the patient moves or remains in a static position

 • Overcautious/overprotective during movements

   Self-limiting range of motion

   Stiff or rigid movements

   Abnormally slow movements

[11, 18, 26, 28, 29, 31,32,33,34,35,36,37,38, 42, 44,45,46, 49, 52, 53, 55, 57,58,59, 61,62,63, 66,67,68,69, 71, 72, 74,75,76,77,78,79,80,81,82, 85,86,87, 89, 90, 92,93,94,95,96,97,98,99,100,101,102,103,104, 106, 107, 109,110,111, 116,117,118,119,120,121,122]

 

 • Strategies to minimize the threat and/or the load on the painful area during movement

   Avoids or minimizes lifting, bending

   Bending knees, kneeling, keeping the back straight

   Moving the feet while rotating

   Imbalance on the distribution of body weight

[11, 18, 27, 28, 30, 32, 33, 37, 42, 45, 50, 52,53,54,55,56,57,58,59, 61,62,63, 66, 67, 69,70,71, 74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89, 92,93,94,95,96,97,98,99,100,101,102,103, 105,106,107,108,109,110, 119, 120, 123, 124]

 

 • Keeps distorted gait despite clinical improvements

   Limps

   Drag one’s leg

[11, 29, 33,34,35,36, 39, 41, 45, 46, 48, 49, 52, 54,55,56, 58, 62,63,64, 73, 74, 83, 84, 88, 91, 105, 113, 115]

 

 • Delays activity execution

   Drinks water between the order and the performance of a requested task/movement

   Latency to initiate a requested task/movement

   Misses therapy sessions if not reminded

[27, 55, 58, 117, 120]

 

 • Excessive rest [34, 35, 43, 44, 51, 54, 55, 60, 62, 63, 70, 74, 84, 88, 105, 118, 119, 124,125,126,127,128]

 

Inconsistent findings during clinical examination

Pain-related behaviors that can be provoked during the clinical examination

 • Discrepancies between:

   clinical findings and observed functional capacity or incapacity (dressing, …)

   the demonstrated range of motion during clinical examination and during distraction tasks

[42, 129, 135]

 

• Overreaction during examination [42, 129, 135]

 

Physical activities

Pain-related behaviors that can be mentioned by the patient while talking about physical activities or performing tasks

 • Avoid or minimize:

   leisure activities

   housework

   sports

   sexual intercourse

[11, 33, 37, 43, 50, 51, 54,55,56, 60, 65, 67, 84, 125, 128, 130, 136]

 

 • Undertakes nothing outside therapy time despite therapist’s encouragement [55]

 

Social and occupational activities

Pain-related behaviors that can be mentioned by the patient while talking about social or occupational activities

 • Avoids or minimizes spending time with people [50, 51, 55, 56, 62, 63, 74, 125]

 

 • Repeated work absences [51, 56]

 

Inappropriate use of

Pain-related behaviors that can be mentioned by the patient while talking about or seen by the therapist

 • Medication (prescribed or not) [27, 29, 45, 46, 51, 54,55,56, 58, 60, 67, 88, 105, 118, 119, 126, 127]

 

 • Healthcare system

   Asking for further specialized medical treatment [51, 55]

 

 • Non-prescribed equipment

   TENS

   Cane or crutch

   Brace

[27, 29, 37, 39, 44, 46, 49, 52, 54, 55, 58, 62, 63, 67, 70, 86,87,88, 105, 119, 127]