Pain

I have recently begun my Musculo Outpatient placement, and have received patients who present with a number of complaints. The majority of the new admissions appear to be post op follow ups, or referred from orthopaedic clinics, which has allowed me to see some variety in diagnosis and presentation. However, many of the current patients at the practice are chronic pain patients who have been presenting for an extended period of time. While I personally have not been assigned any of these chronic pain patients, I have assisted or observed the assessments of the supervisors. Some of these patients have presented with pain that has lasted for over 20 years, and in some cases the patient has had the pain longer then they haven't. The majority of patients appear to have acquired the pains through work related accidents or injuries, with some as a result of trauma. What I have noticed through the observation of the senior physiotherapists is that the treatment for the pain patients appears to involve very little intervention. For the most part advice and education on self management play a far more significant role then any sort of manipulation. I was informed that the reason for this is due to the psycho-social yellow flags that we observe for during an assessment. The supervisor informed me the applying an intervention such as mobilisations or manipulations for a chronic pain patient is much less effective then self management and education in terms of patient outcomes. Promoting self management decreases the chance of the patient becoming dependant on intervention to function, and also is more likely to allow the patient to remain independant. I have also learnt that with chronic pain patients their response to treatment is as dependant on their physical state as their psychological state. The supervisors have told me that the patients who manage their pain the best are the realists, who acknowledge they will always have pain regardless of treatment. It is the patients who expect a miracle cure who then cease treatment when they don't get the results they expected, which in turn directly impacts their quality of life. Even though I am only a week into my current placement, I feel that I have a greater appreciation of the impact of a clients outlook on their condition, as well as the psychological state, especially when dealing with an issue such as chronic pain.