As treating physical therapists we are well aware of the positive effects we can have on facilitating symptom management and improving overall function in a collaborative effort with our clients. Working with clients, who are in chronic pain, we are also aware that the drugs prescribed are often not solely effective in managing pain and do little to normalize movement, restore function and/or address fear of re-injury. The Center for Disease Control and Prevention (CDC) has urged health care providers to reduce the use of opioids in favor of safer, and often more effective, treatments such as physical therapy. The APTA has taken an active role in educating the public and health care providers in the benefits of physical therapy in the treatment of pain and dysfunction. It has done this most recently in its #Choose PT campaign. “Opioids come with numerous serious side effects and only mask the sensation of pain,” stated #ChoosePT campaign spokesperson Joseph Brence, PT, DPT. “Research shows that physical therapist treatment can reduce or eliminate the need for opioids by improving physical function, increasing range of motion, and decreasing pain."
However, treating persons in chronic pain can come with many challenges. Living with chronic pain is miserable. If you are living with chronic pain it makes sense that you are often also depressed, sleep deprived and anxious. As a relatively healthy person, I am grateful for an acute/painful injury sustained during a recreational activity or the isolated headache to have the physical reminder of how brutal pain can be. I am also grateful that the pain I experience is usually temporary and that I have an above average understanding of pain physiology. During my final clinical rotation as a physical therapy student, I had the opportunity to work with a Clinical Instructor who was part of an interdisciplinary team for the treatment of clients with chronic pain. We had weekly meetings with the treating physicians, the anesthesiologists, cognitive-behavioral psychologists and nurse practitioners/case managers. Utilizing a team approach is essential when working with this population and I learned a lot. In addition to these team meetings, my CI had me read just about everything in the literature published by Lorimer Moseley and David Butler particularly, the research relating to complex regional pain syndrome. As a student project, I painstakingly posed for, photographed and printed a series of photographs of my left and right hands in various postures that were then laminated and cut into “flash cards” to be used by client's for laterality recognition tasks and imaginary (mass) practice for the primary purpose of cortical de-sensitization, symptom management and improved function.
If any of this sounds familiar you have likely read Explain Pain or other published works relating to graded motor imagery, neurodynamics or pain neuroscience education (PNE). Things have come a long way since homemade flash cards. There is now an online laterality recognition program called Recognize to assist in the treatment of chronic pain conditions like CRPS. In addition to the books like Explain Pain and Painful Yarns, resources abound for the treatment of chronic pain conditions. The Neuro-Orthopedic Institute (NOI) group website offers online resources, programs as well as live lectures on topics ranging from the Sensitive Nervous System, Graded Motor Imagery and the Mobilization of the Neuro-Immune System. However, it all started with the book Explain Pain and the lecture series that accompanies it. It also remains as one of the most sought after lectures and will be coming to Whitefish, MT for the Spring MAPTA conference on April 22-23. You can learn more about the course from either the MAPTA (http://www.mapta.com/event-2388660) or NOI (http://www.noigroup.com/en/Courses) website. In addition, you can check out this Explain Pain “trailer”: https://www.youtube.com/watch?v=zCGvNwJDtvU, or this Ted Talk by Moseley called Why Things Hurt?: https://www.youtube.com/watch?v=gwd-wLdIHjs.
Looking forward to seeing you in Whitefish!