I strongly agree with your final statement Ian. When reviewing the
literature on chronic pain management recently, there was very strong
evidence for multimodal and multidisciplinary involvement. I now work very
closely with a clinical psychologist. It is becoming increasingly evident to
me now how a patient's thoughts and beliefs about their pain can also
influence their pain behaviour and how simply by looking at the physical
aspects, we can never hope to achieve our aims. We often need to remind
ourselves that in the true chronic pain population, should indeed our aim be
to decrease pain. I believe this is not the case.
Karen (research physio)
>From: "Ian & Colette Stevens" <[log in to unmask]>
>Reply-To: [log in to unmask]
>To: <[log in to unmask]>
>Subject: Re: REFERED PAIN;A PUZZLING DISGUISE
>Date: Fri, 14 May 1999 09:45:34 +0100
>
>As previously described and references sent( I think) the search for the
>pathology in usually chronic cases (the only time most physiotherapists in
>the British NHS see patients) has to consider the type of pain mechanism
>operating rather than the tissue involved . This makes the job more
>interesting and probably more difficult too . Many many disasters occur in
>orthopaedic medicine when the sensitive tissue or area is deemed to be the
>source of the problem rather than a reflection in many cases of abnormal
>processing in the cns . Probably better to look at concepts and models such
>as 'wind up' and 'central sensitisation' in the dorsal horn to explain
>ongoing problems rather than tradditional 'mechanical explanations' of
>dysfunction . Have a look at the Textbook of pain edited by Patrick Wall or
>articles by Milton Cohen and Australian Rheumatologoist to explain cases
>you describe.
>However like the descriptions you describe many people persist in outmoded
>inflammatory models to explain ongoing problems such as so called tennis
>elbow when in all probability the nervous system itself is more likely to
>be the problem?
>Where I work most shoulders get heaps of injections ...... often with
>little or no benefit,knees get released or patallectomies get performed and
>loads of chronic vague elbow symptoms get injected time and again .........
>A vague knowledge of pain mechanisms ,explanation, graduated rehabilitaion
>etc is usually far more valuable than most forms of unimodal
>intervention......
>
>ian stevens glasgow uk
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