Physiotherapists Helping People With Chronic Pain
Chronic pain causes suffering for patients and managing chronic pain is one of the most common assignments in the health service. It is important to realize that the patient with chronic pain is the patient who has experienced an upregulated central nervous system (CNS). With all the issues associated with the accident (stress, anxiety, fear, failed treatment, different explanations of the injury), the CNS heightened its sensitivity as a means of survival, a process referred to as central sensitivity or secondary hyperalgesia. So what should we do (as physiotherapists) to help people with chronic pain?
Tip #1: Identify patients with “red flags”
Patients with a red flag should be referred for additional testing and medical management.
Tip #2: Educate the patient about the nature of the problem
Recent research has evaluated the use of neuroscience education in decreasing pain and disability among patients with chronic pain. It is recommended that therapists educate patients more regarding their pain as opposed to only using anatomy models.
Tip #3: Provide prognostication
Physiotherapists should focus on function rather than pain and then set attainable goals related to exercise, function, and social interaction.
Tip #4: Promote self-care
A powerful management strategy for patients with chronic pain is to teach them strategies to help themselves. This fosters greater independence and helps with the development of coping strategies, teaching patients that they are able to manage their own pain.
Tip #5: Get patients moving and active as early as possible
Movement is essential. There are many reasons to get patients to move soon after injury, including (from a biological perspective) blood flow, removal of irritant substances, and (from a psychological aspect) coping strategies, empowerment, and more.
Tip #6: Decrease unnecessary fear related to movement, leisure, and work activities
Therapists should aim to educate their patients suffering pain and thus reduce fear.
Tip #7: Help the patient experience success
Encouragement is important. Patients with chronic pain have numerous psychological comorbidities such as depression, poor body image, and lack of self-confidence.
Tip #8: Make any treatment strategy as closely linked to evidence of the biological nature of the problem rather than syndrome
The physiotherapists should explain to the patient what happens on a biological level that causes the pain and what can be done. There is growing evidence that the more patients understand the biology behind their pain, the better understanding of the pathology they have and the better their understanding of the proposed treatment plan. This is another cornerstone of neuroscience education— “biologizing” a patient’s pain.
Tip #9: Consider multidisciplinary management
Physiotherapists should based on their experience and evaluation, decide if a patient may need additional help (psychologist, physician, etc).
Tip #10: Assess and assist recovery of general physical fitness
A vast body of evidence supports the use of aerobic exercise in the management of patients with chronic pain. Therapists should help patients develop a home exercise program that includes a large focus on aerobic exercise.
• Moseley GL, Butler DS. 15 Years of Explaining Pain – The Past, Present and Future. Journal of Pain. 2015. https://doi.org/10.1016/j.jpain.2015.05.005 • Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017. https://doi.org/10.1002/msc.1191 • Louw A, Zimney K, O’Hotto C, Hilton S. The clinical application of teaching people about pain, Physiotherapy Theory and Practice. 2016. https://doi.org/10.1080/09593985.2016.1194652