Patients have lived a lifetime of ups and downs; successes and set backs prior to entering a PM&R clinic for treatment. The impact of an individual’s prior life experiences on their current physical and mental wellbeing cannot be underestimated. Likewise the individuals past experiences often serve as the foundation for the development of their expectations of themselves and those around them. Clinicians should be sensitive to the fact that each patient has a unique background that will contribute to their clinical outcome.


A patient past history should explore past medical history, prior evaluations/treatments, physical demands at work/recreation, psychiatric history, social stressors, substance abuse, family medical/psychiatric history, history of physical/sexual abuse and other barriers to clinical success (insurance, education, pharmacy access, support network).

Clues from the Past - Risk for Chronic Disablity


Clinicians should be on the look out for patients that are at higher risk to become chronically disabled. It has been recommended that aggressive efforts should be made with this population to prevent chronic disability. 

 
Clinical Factors
  • Multiple previous musculoskeletal complaints
  • Psychiatric history 
  • Alcohol, drugs, cigarettes

Pain Experience
  • Rate pain as severe
  • Maladaptive pain beliefs ("Pain will not get better, surgery is the only cure")
  • Legal issues or compensation  
Premorbid Factors
  • Rate job as physically demanding
  • Believe they will not be working in 6 months
  • Don’t get along with supervisors or coworkers
  • Near to retirement
  • Family history of depression
  • Enabling spouse
  • Are unmarried or have been married multiple times
  • Low socioeconomic status
  • Troubled childhood (abuse, parental death, alcohol, difficult divorce)