The mind and the body are clearly intertwined in ways that are only now being discovered. In the orthopaedic world, injuries and diseases are often classified and described in a very organized, discrete fashion—The radius is fractured, the ACL or meniscus or rotator cuff is torn, the ankle is sprained, and/or the lumbar spine has a disc herniation. Although it is, in many ways, almost comforting to think about injuries or orthopaedic issues in this manner, what about the many patients who fail to fall into this classification? What about the thousands of patients with severe unexplained chronic pain or patients who just are not improving with the typical treatment algorithm. What about patients who present with multiple overlapping symptoms that do not fall into any of the classic diagnosis patterns? The mismatch between the actual health needs of typical patients and the standard acute medical response produces an immense waste of medical resources and incredible frustration for both the patient and the provider and creates a real risk that acute conditions will go untreated and become chronic. After more than a decade of traditional orthopaedic and musculoskeletal practice, its tremendous benefits as well as its limitations have become apparent. These limitations have sparked a search for integration of mind–body considerations to fill some of these gaps. Although this can prove to be quite challenging in today's healthcare world of maximizing volume and decreasing costs, it has proven to be an invaluable resource for both personal growth and patient and family satisfaction. The goals of this 2-part article are to dissect the relatively new concept of the mind–body connection in orthopaedics. The article aims to provide a framework that illustrates how the mind will predictably create objective observable phenomena in the body. The central focus of this framework is the role of the sympathetic nervous system and its effect on the chemistry, biomechanics, and appearance of various tissues in the body. Further identified are factors contributing to the aberrant emotional response as a means to empower practitioners and patients in recognizing the link between negative perception and observable symptoms. Our hope is to ultimately introduce a model of empowerment that when presented to a patient/family can produce a proactive response and, in turn, enhance current orthopaedic and pain management practices.
Erin Sullivan, CPNP, Department of Orthopaedic Surgery, Yawkey Center for Outpatient Care, Massachusetts General Hospital for Children, Boston.
Jeremy Hudson, MSPT, Sollus Therapeutics LLC, 137 Newbury Street, Boston, MA.
The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.