How to ensure our patients with chronic pain are “Actually Ok”?

Last week we saw an unprecedented amount of awareness for acknowledging the movement R u ok? The multi-dimensional community push for drawing awareness to mental health issues in society appears to be gaining traction.

There has also been plenty of media around the impact of COVID-19 on mental illness, and the damage this pandemic is causing to individuals and families across the globe.

What we notice daily with patients suffering from persistent pain, is the comorbidities of depression, anxiety and adjustment disorders can frequently feature, complicating further each patient’s overall presentation, and the effectiveness of traditional medical approaches to assisting rehabilitation outcomes.

It has become a vital part of our assessment and treatment approach to flag for and help address any patient’s signs of mental illness. By failing to do so we only impede on our own abilities to help patient’s recovery.

Although most of us are not psychologists or psychiatrists, health professionals have all studied psychology as part of our qualifications, and spend a significant amount of time with patients listening to them describe their pain history’s, as well as educating them to understand and manage their presentations.

Should we not “hear and validate” our patient’s concerns it makes it very difficult to get effective outcomes for addressing their pain experiences.

Our patient’s treatment experience can be improved dramatically by simply acknowledging and addressing human considerations such as:

– verbal and nonverbal cues;

– active listening skills;

– socratic questioning/motivational interviewing leading to patient empowerment;

– providing empathy and validation;

– discuss pacing and active (as opposed to passive) relaxation strategies.

Specifically, we need to consider 4 key factors to develop a simple “tool-box” of effective pain management strategies to improve physical activity and overcome biopsychosocial aspects for pain, thus ensuring best outcomes!!

Step 1: Pain Education
Facilitating understanding for each patient regarding “hurt vs harm” – just because things may seem painful at first when initially getting going, this doesn’t mean they are actually causing you harm, or your “problem” is getting worse. Most of the time these types of symptoms are reflective of your nervous system de-sensitising and adjusting to you moving once again. It’s Ok to Move! As long as it’s measured!!

Step 2: Mindfulness
Working on one’s mindset and attitudes towards pain is vital. By this we mean that the associated mood and stress impact from persistent pain is completely normal, and unless channeled, can become as equally unhelpful to your ongoing pain experience to that of initial physical injuries.

By using relaxation and other psychological techniques such as mindfulness, one can actively learn to take control of their natural thoughts around apprehension from pain, and simply increase their function in progressive bursts knowing they are on the road to recovery. Working with a counsellor or psychologist can be particularly helpful here when initially trying to develop these skills.

Step 3: Tailored Exercise Programs
When considering the role of exercise, it’s highly likely a person with pain has attempted stretches or exercises before as part of an initial treatment program. There are many types of back exercise programs, these range from aquatic or hydrotherapy, core exercises, clinical Pilates and yoga, resistance/weights programs, and cardiovascular exercise (step count walking, swimming etc).

Progressing exercises to ultimately those which are simulating activities of daily living for each person is best practice. Our Core Physiotherapists’ role is to individualise each patient’s exercise program to ensure maximum results, in the most rapid time frame.

Step 4. Modifying Lifestyles
The fourth and final piece of solving the persistent pain puzzle is the need to understand and refine ergonomic and lifestyle strategies when moving – because prevention really is better than cure!

Considerations to one’s diet and medication regime is important to ensure there are no unknowing contributing influences to one’s pain experience. Some medications may no longer be appropriate for pain management, and ironically can be part of the problem, contributing to one’s pain experience.

One of the most important lifestyle skills in back pain management is “Pacing” – either planned or reflective in nature. Understanding the need to focus on the quality of what you are doing, and not necessarily the quantity is vital. The cliche “slow and steady wins the race” summarises pacing skills nicely for tackling persistent pain.

In summary, the persistent pain sufferer must become the expert in knowing and understanding their current capacity limitations – to ensure control over building these over time through pacing strategies.

Often shifting your focus to what you can do with pain, as opposed to what you can’t do because of pain is a very helpful starting point to begin your pain management strategy.

If you are, or know of anyone who might currently be losing the battle with persistent pain, and they are currently undertaking some of the previously mentioned medical approaches in hope of change, to ensure “they are ok” make them aware that current evidence suggests these interventions will more likely than not, lead to poor outcomes.