Georgie Oldfield discusses the psychological issues that can trigger feelings of pain.
Why is it that, despite the importance of evidence-based studies, it still takes so long for relevant research to filter down and result in changes at the clinical interface?
This has been the case with chronic pain and its treatment, but when will the evidence base reach the clinical interface?
Studies into MRI scans and spinal degeneration since the 1970s have demonstrated the lack of correlation between pain and spinal degeneration, yet treatments still focus on any structural ‘abnormality’ found.
Even when a condition is medically unexplained, more often than not, a physical approach is still used to try and address the physical symptoms – often still leaving patients suffering with pain.
When are we as a profession (and the medical world in general), going to open up and push the boundaries (as we are encouraged to do by the CSP), and actually take on board evidence demonstrating the lack of correlation between pain and posture, structure and biomechanics?
As a physio, for many years I questioned the anomalies between patients’ signs, symptoms and diagnoses and read widely searching for an answer.
So coming across the concept on which the stress induced pain recovery programme approach is based was a real ‘aha’ moment for me.
I understand though that for many people this approach will be hugely challenging, but for many others it could well cause their own ‘aha’ moment.
The link between the brain and pain is not actually as big a step as many feel, because through the ‘explain pain’ work and the use of cognitive behavioural therapy and mindfulness, it has become widely recognised how important psychosocial factors are in chronic pain.
Unfortunately the focus is still on management, based on the understanding that there must be a physical cause, even when none can be found.
However, once it is accepted by the patient that the pain (plus muscle spasm or weakness) is created by the brain and central nervous system as part of a primal stress-processing response then recovery is possible because the process is reversible.
More often than not recovery occurs with a patient’s own self-directed approach, or with support and guidance from a practitioner, without the need for psychotherapy.
Georgie Oldfield is a physiotherapist and pain specialist at the Pain Relief Centre, Huddersfield
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