Physiotherapy for chronic pain – it is not all the same!
A physiotherapist’s approach to managing chronic pain should incorporate an active rather than passive approach. A passive approach is when treatment is “done” to the client and the client is overly reliant on their treater. This not only includes hands on treatment or electrotherapy but also an excessively supervised exercise program where the client is unable to confidently modify their exercise program. In contrast, an active approach empowers a client to understand their condition, utilises supervised exercise as a “training ground” to teach the client how to independently upgrade (or temporarily downgrade) their exercise program and how to implement strategies independently to cope with any setbacks.
Physiotherapy sessions may include the provision of education to challenge a client’s fear that all pain relates to further injury or harm, a graded increase in exercise and activity, general exercise for global reconditioning and to improve mood levels, goal setting and the development of a range of self management strategies that the client may confidently implement to prevent flare ups in pain or to manage exacerbations in pain. The physiotherapist needs to adopt a coaching role, assisting the client to problem solve, rather than a traditional treatment plan.
Goals of treatment may include a return to suitable work, independence with domestic activities, re-engagement in leisure activities and a reduction and cessation of reliance on ineffective pain medications. It is unlikely to be straightforward or easy and people with chronic pain may experience regular set backs during treatment. Indeed it may take many episodes for the person to be consistently confident that they can effectively self manage. However, as this occurs, the frequency of treatment sessions should reduce.
A return to “passive therapies” to manage flare ups in pain is likely to undermine previous efforts made to empower a client in pain to gain control over their pain. Achieving self management is not easy for most people who experience chronic or persistent pain. The risk with providing passive techniques for pain relief is that it may erode a person’s confidence to self manage and may lead to a dependency for passive treatment.
Physiotherapists have a valuable and significant role in empowering clients to manage their pain effectively in order to re-engage in activities that are meaningful to them.more hot topics ›