If you’re a physiotherapist and you treat chronic pain or you’re a person in pain receiving treatment, then chances are you’ve been faced with a range of presenting symptoms outside of the straight-up physical. If you’ve ever wondered how best to handle curve-ball issues like the emotional stress and social isolation that come with long-term pain then it might be time to broaden your approach to chronic pain management.
Over the last decade, the allied health industry has increasingly shifted away from a biological model of pain — the idea that pain is looked upon simply as a sensory response to a specific injury.
A rack of exercise balls.
Chronic pain management, is now increasingly approached as a collaborative effort; with physiotherapists, psychologists, occupational therapists and other allied health clinicians banding together to deliver a tailored suite of treatment options to people with pain.
This month, we’d like to talk more specifically about approaches to chronic pain management in the physiotherapy industry – somewhere we think has a lot of potential for increasing its offering.
In a recent report by NSW physiotherapist Shelley Barlow, of Ballina Community Health, a number of issues were raised with regard to the average Australian physio’s limited breadth of knowledge when it comes to effective chronic pain management – and given that it’s coming from a highly experienced physio, we thought it raised some interesting points.
In the report Barlow says,
“Physiotherapists often lack knowledge of the theoretical underpinnings of chronic pain management. The lack of knowledge of and use of a biopsychosocial assessment and identification process means people with chronic pain are managed as if they have acute pain”.
She also goes on to say that in general, physiotherapists’ outpatient pain management models don’t take into account the differences in treating acute pain (short term pain, no longer than 6 months) and chronic pain (where the pain lasts for 3-6 months or longer).
“People with chronic pain are not being identified in physiotherapy outpatients as needing different interventions to people with acute pain”.
And it’s fairly safe to say that outpatient physio services are generally much more geared to maximising outcomes for acute pain patients than they are for patients with chronic pain.
Here are some of the issues that Barlow outlined in her report:
Outpatient physio services are designed for quick turnaround and for addressing acute (rather than chronic) conditions
Physiotherapy training has traditionally focused on biomedical and biomechanical assessment processes
Physios feel that working with chronic pain is difficult
Dealing with emotional distress is uncomfortable and most physios don’t feel adequately trained to manage this side of things
Poor access to new information and training due to geographical and professional isolation prevents new practices from gaining traction.
What’s really important when treating chronic pain patients is to ensure that they are engaged in treatment. One of the best ways to do this is to ensure that the right kind of treatment environment is created. This means having a plan (not just a couple of sessions) and making sure that the process is not rushed.
It can be really useful for physios working in this area to develop skills for managing the (often significant) psychosocial barriers that impact on chronic pain patients – understanding things like fear avoidance, change readiness, self-efficacy, depression and stress and how they can impact on the patient’s broader treatment outcomes.
The good news is that this is the kind of work that we’re absolutely passionate about! There are also lots of great resources (for physiotherapists and their patients) on the Pain Australia website.
