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Surely not Kevin Reese infamous at 1990-1993 University of Northumbria at Newcastle??? Anyhow I have been fascinated by this ongoing debate concerning manual therapy approaches and the pro's and con's of differing models in the management of low back pain. I wonder if all this energy could be harnessed in helping me (as a non-specialist respiratory physio!) answer two questions for a proposed research trial of opioids in chronic pain: The specific questions are:- 1)What might be the anticipated average reduction in the patients analgesic consumption when physiotherapy is "effective" (i.e. any favourable response) in the management of chronic back pain? 2)How would this be measured and interpreted clinically (if at all)? Hope somebody might have a measure on this. In anticipation! Alistair Grant >From: "kevin reese" <[log in to unmask]> >Reply-To: [log in to unmask] >To: <[log in to unmask]> >Subject: Re: spinal psychology >Date: Tue, 7 Mar 2000 18:56:24 -0000 > >Dear Ian > >By far the most sensible answer on this topic to date. You neither imply >that these points have been proven (philosophically is this possible) or we >ditch our traditional skills after 3/52. > >Giffords 10 minute, 1999 CSP Conference presentation was head and shoulders >the best. The layered analagies for genetisist to politician is exactly the >the right conceptualisation of pain in my view. We can all alter a window >in >the greater picture, should have a good awareness of the other factors >influencing pain, but realise our strengths. > >I feel we can present lots of evidence for and against most issues and I >think previous fads in physio like MET and MB are being replaced by the >psychosocial approach; perhaps the most recent fad. > >Nice reply and I'll shut up for a bit. Regards Kevin > > >-----Original Message----- >From: Ian & Colette Stevens <[log in to unmask]> >To: [log in to unmask] <[log in to unmask]> >Date: 07 March 2000 14:05 >Subject: Re: spinal psychology > > > >Kevin, > > > >I have replied to this on two occasions but owing to little hands my >replies > >got deleted ! > > > >However briefly to an altogether complex multifaceted problem Kevin I >will > >offer some thoughts ...... > > > >Using a different model for the assessment of psychological V's physical > >dysfunction may be worthwhile and make one aware of the complexities and > >multifaceted nature of the person before you. Wherever possible I try to >use > >Louis MOM approach, analysed from this perspective the model may serve to > >minimise dualistic interpretations of facet/imbalance or whatever else >is > >in vogue in physio circles V's supratentorial ... > > > >However with this in mind it is certainly advisable for a person >interested > >in manual therapy to be aware of the issues outside their interpretation >of > >physical dysfunction .... It is so easy to search endlessly for a tissue > >based solution to explain benign low back or for that matter >cervicobrachial > >pain before the patient trundles off somewhere else or ends up at a pain > >management clinic . > >If the literature is to be believed and my clinical practice certainly > >reflected this, Kendalls work on yellow flags for poor outcome should be > >widely disseminated . > >Simple questions on presentation should be what do you think is wrong >with > >you ? If you give a purely mechanical structural answer or solution many > >people will become disabled .... which is exactly what has happened read > >Zussmanns excellent essay, Waddells back pain revolution or ask patients > >what they were told ...... > >However this again is a complex issue as many people obviously respond to > >the analogies of things being pushed in and out and some therapists make >a > >fortune doing and telling people this ( depends who is doing the probing/ > >how expensive/ distance travelled and impressiveness etc etc).... > >Additionally as a culture the usual response is to treat ones body like a > >car and the intervention is usually analysed in this fashion too --- in > >grey areas like musculoskeletal pain the intervention certainly is not > >simplistic as we all know ....but people like simple solutions to complex > >problems therapists/patients alike... > > > >We should as a profession be much more aware of the complex interaction >as > >people becoming disabled with benign 'mechanical' problems are increasing > >not reducing in number ? > >However this requires in many instances a shift to happen in therapists > >education and the issues associated with musuloskeletal pain to be >better > >understood or at least be valued ......This doesn't mean being a > >psychologist but often a subtle shift in intention during treatment not > >slotting people into boxes because they fit into categories who may or >may > >not become chronically disabled..... > >If the epiemiology statistics were to be believed no patient in my last > >place of employment would have got better at all ( poorest health in UK, > >massive unemployment, little if any place of leisure , and family > >dysfunction++ typical of many nhs deepest in inner cities I am sure). > > > >It does have to be said that depts as above do need multidisciplinary >teams > >to have a chance with this common group . In order to be therapeutic and >to > >have a successful outcome with more patients it is necessary for >therapists > >themselves to be healthy . Knowledge is one way forward but it has to be > >said that treating people who have been around the houses, given >erroneous > >information and who are often at their wits end is a thankless task > >......... > > > >all the best to you > > > >Ian p.s I am looking for a new job! > > > ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%