Hello Karen and Ian,
I would certainly support your comments and as you alluded, unless physios
start treating chronic pain differently to acute pain, they will not be
successful in managing the problem.
Let us not forget our roots in exercise/movement which is the crux of
chronic pain management, in conjunction with a cognitive behavioural
approach - oh dear all those psych/behav science lectures skipped as
students!!
With chronic pain we MUST focus on function not pain!
There are a lot of evidence (research and anecdotal) supporting this
strategy.
Cheers,
Anna
Anna Lee.
Principal, Work Ready
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-----Original Message-----
From: karen robb <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Friday, 14 May 1999 19:47
Subject: Re: REFERED PAIN;A PUZZLING DISGUISE
>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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