How can therapy support pain management?

by John Scott

The longer the pain lasts, the more difficult it is to treat. The research strongly suggests that a mixture of physical and psychological therapies offers the best chance for improving outcomes. One of the most common forms of pain affects the lower back. Yet it is often the case that there is no biological evidence of the cause of the pain. No apparent external injury. No x-ray or other scan image of internal injury. The most usual association is with changes in mood, variations in the levels of anxiety or stress, or social episodes which trigger the sensation of pain. In other words, the way you perceive pain cannot be divorced from you as a person and the collection of memories and experiences that define you as an individual. So if pain persists despite the standard medical treatments (including the use of drugs such as tramadol), it is time to expand the range of treatment to include therapy.

The primary problem is that people quite naturally make their own condition worse. When they feel pain, they stop moving. They generally avoid doing the things most likely to cause the pain. More often than not, this means they rest. Unfortunately, when you rest, you lose muscle tone and tend to become stiff. This actually worsens the initial condition. Because you feel you cannot continue to function, you lose self-respect. Now confining yourself to bed, you lose your role as breadwinner or homemaker. This may impose financial hardship on the family or damage your relationship. As your mood darkens, depression can further amplify the symptoms.

Physicians are trained to apply a “scientific” approach to patient care. They make a diagnosis and supply the treatment recommended. If the diagnosis is correct, the patient gets better. Psychiatrists and therapists do not deal with the world in such black-and-white terms. They take a more holistic view of the patient. If there is disability and distress, those symptoms should also be addressed. The intention is to improve the way in which anyone deals with the pain. It offers coping strategies, problem solving and giving people a way to resume activities and thus relieve frustration. The more people can be given back some control over their lives, the more likely it is that they will begin to think more positively about their situation.

It is important to begin with physical therapy to improve mobility. Therapists will analyze activities and teach people how to get the same results by modifying their behavior. Add in relaxation training and stress management exercises, and you now begin to see a more complete route to recovery. This is a team effort with psychologists working alongside occupational therapists, physicians and nurses. Thus, if a physiotherapist gains some insight into the beliefs and fears a patient has about mobility, a program of reward and reinforcement can be established which teaches people about how their body works and why their fears are exaggerated. Noone can force you into anything. But if you are shown a better way, most will take it if given the right incentives.

Not everyone does respond to therapy, resisting interference in the way “they” do things. It also relies on effective management of the team expected to deliver these results. So, it is easy for non-medical treatment to fail (which will often confirm the patient’s prejudices). But there are many who do respond well, moving away from reliance on drugs such as tramadol as they learn how to function within the limits set by their bodies (and minds). Unfortunately, this approach is expensive. A physician sees a patient for a few minutes, writes a prescription and moves on to the next patient. This is an “efficient” use of resources. The behavioral model requires more people. Conventional hospital and health service models find this an uneconomic use of scarce resources (often choosing not to research the effectiveness of this approach to treatment). Nevertheless, there is a growing and substantial body of research now attesting to the effectiveness of this form of approach. If you have chronic pain, you should consider it.

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Article Source: How can therapy support pain management?

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