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An alternative approach

in treating the pain of

Up to 4.2m working days are lost in Britain each year through employees suffering upper

limb disorders, costing employers an estimated £5-10bn in lost productivity.

A study in 2000 at the University

of Manchester foundWork Related

Upper Limb Disorder (WRULD)

was not solely caused by physical

action. Several other factors, including

high levels of psychological distress

and dissatisfaction with support

from colleagues at work, could also

contribute to the condition. There is

also emerging evidence that a mixture

of exposure to both physical and

psychosocial factors at work has a

stronger association than either type

of factor alone (Devereux et al. 2004).

The reason an individual who is

experiencing symptoms of pain

decides to get help is not always

clear, but the decision seems to often

include a conclusion that one can no

longer cope, or fear that something

serious has happened (Hadler 2005).

More specifically, Mallen et al. 2007

found individual psychological factors

such as anxiety, distress and depression

have consistently been found to be

associated with various aspects of

Upper Limb Disorders.

Studies withWRULD patients have

shown that a Cognitive Behavioural

Therapy (CBT) approach can be

beneficial in reducing symptoms

of pain, psychological distress and

interference in daily living.The CBT

approach can include relaxation

training, goal setting to increase

activity levels, attention diversion

methods for dealing with pain, and

cognitive challenging of maladaptive

beliefs and misconceptions.

CBT helps provide pain relief in

various ways. Firstly, it changes the

way people view their pain. Patients

can hold ideas that may be harmful, in

the sense that they encourage beliefs

and behaviours that are unhelpful,

and contribute to reduced levels of

activity, higher levels of distress, and a

tendency to consume more healthcare,

as well as extended absence.

CBT can also change the physical

response in the brain that makes pain

worse. Pain causes stress, and stress

affects pain control chemicals in the

brain, such as norepinephrine and

serotonin. CBT reduces the arousal

that impacts these chemicals. This, in

effect, may make the body’s natural

pain relief response more powerful.

Cognitive Behavioural Therapy also

encourages a problem-solving position.

The worst thing about chronic

pain can be the sense of learned

helplessness. If the patient takes

action against the pain, they will feel

more in control, and able to impact

the situation. CBT often includes

homework assignments. These may

involve keeping track of the thoughts

and feelings associated with the

patient’s pain throughout the day, for

example in a diary. Assignments can

then be discussed in each session and

used to plan new homework for the

following week. CBT can be seen as

skills training. It equips patients with

coping mechanisms they can use in

everyday situations.

Crawford & Laiou, 2007, found that

pain management programmes, using

cognitive-behavioural principles,

and multidisciplinary occupational

rehabilitation for people with

WRULDs, can improve occupational

outcomes in the short-term, and

significantly reduce sickness absence

in the longer term with an earlier

intervention yielding better results.

London Bridge Hospital aims to

provide a comprehensive approach

to treatingWRULDs.We are focused

on offering patients a professional and

specialised service incorporating a

multidisciplinary approach to care.

Repetitive Strain Injuries

For further information, please call Ruth Jennings, CBT Specialist on:

T: 020 7234 2500



[email protected]


Repetitive Strain Injuries