FfW Bulgarian report (English language) - Fit for Work Europe

4.4
The
biopsychosocial
model and work
Interventions
52
area where more support could be provided is psychological support. As noted previously,
the psychological effects of RA can be an important factor in managing the impact of disease,
including the belief that people can recover, however, it seems that there is currently no
government support available for psychological interventions for those with chronic conditions
and patient groups are limited as to what they can fund. 41
Prompt referral to specialists for confirmation of diagnosis and the start of treatment is also
essential for those with AS and other rheumatic conditions, however, due to difficulty with
diagnosis this does not seem to be happening in Bulgaria. 42 4.3.3 Spondyloarthropathies
Since (similarly to RA) there is
no cure for AS, the aim of therapeutic intervention is to reduce inflammation, control pain
and stiffness, alleviate systemic symptoms such as fatigue, and to slow or stop the long-term
progression of the disease. The prescription of non-steroidal anti-inflammatory (NSAIDS) or
anti-TNF drugs coupled with regular physiotherapy forms the current basis for the treatment of
AS.
As AS typically affects relatively young people, its potential to disrupt or even curtail an
individual’s labour market participation may be significant. As we have discussed, there are
important clinical, social and economic benefits to keeping these patients in work as long
and consistently as possible. Depending on the severity of their condition, AS patients can
benefit from workplace adjustments, flexible working arrangements, exercise regimes and
physiotherapy (Boonen et al., 2001).
The biopsychosocial model advocates that clinicians, occupational health professionals and
others should assess the interplay between the biological (eg disease, joint damage), the
psychological (eg disposition, anxiety) and the social (eg work demands, family support).
Clearly, the psychological disposition and behaviour of a patient can have a significant impact
on the way a physical ‘injury’ (such as back pain) is approached by a patient. In some cases
the patient risks entering a self-reinforcing cycle of incapacity, delayed recovery and even
depression if their dominant response to pain is to ‘catastrophise’ it. Of course there may be
many factors which affect an individual’s disposition to ‘catastrophise’, including personality,
previous medical history, levels of family support or job satisfaction (Sullivan and D’Eon,
1990). It is evident that the interaction of the biological, psychological and social dimensions
can have a significant impact on the development, progression of, and rehabilitation from, a
musculoskeletal condition.
41 Expert interview
42 Expert interview
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