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Whole-person approach to treatment

Congress delegates were urged to look beyond the body if they are to overcome one of Western Europe's biggest health problems - low back pain.

Physiotherapist Anne Daykin, a clinical research fellow at the University of Warwick's medical school, advocates a biopsychosocial approach to the treatment of low back pain.

One aspect of this is to identify and target potential obstacles to recovery. These are clinical predictors of outcome, Dr Daykin said. Therefore, efforts to manage them may reduce the economic and personal burden of low back pain. 'When talking about psychosocial factors we need to remember that these relate to individual risk factors and work-related risk factors. Facilitating return to work is one of the hardest goals,' Dr Daykin said.

Occupational risk factors include low social support in the workplace and low job satisfaction, she said, reminding delegates: 'Pain always has an emotional element to it. Distress may raise awareness of bodily sensations and increase sensitivity to pain.'
Joint goal setting and problem solving could reap rewards, she said. And it was also beneficial to explain the difference between acute and persistent pain and identify the beliefs associated with pain. 'Patients and health professionals need to work together towards a common goal.'

People react variably to pain, she stressed. Some commit themselves to physical activity and recovery after an injury while others assume there is 'something dangerously wrong' with their body.'An enlightened clinician will see pain as a dynamic interaction between a multitude of influences and manage it accordingly and appropriately. 'The hard part is to get the balance right between physical assessment and the biopsychosocial approach,' Dr Daykin concluded. 'Our philosophy should really focus on self-management.'

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