Module 6: SURG0130: Strategies for the self-management of pain.

As an osteopath, all my clinical work treating a variety of musculoskeletal pain patients involves hands-on treatment plus providing a tailor-made exercise/rehabilitation plan for that particular patient. This module was interesting, as it addresses how we can help pain using a non-pharmacological, non-invasive approach, ie a lot of what I do every day.

I particularly liked the tutorial given by J Proskewitz on non-specific lower back pain. I feel that he and I are very similar in our assessment, treatment and rehabilitation approaches and philosophies. I am in agreement that patients most definitely do want a clear explanation given to them about their condition, as usually, they have seen many therapists before getting to me, all of whom often contradict each other. The poor patient ends up confused, and wonders if there’s anyone out there who understands them and their needs, which of course contributes to central sensitisation, and perhaps even becomes a barrier to getting treatment. It’s a greater challenge to change a patient's mindset that you can help them, rather than you're just another person who likely can’t.  It's also really important to talk to the patient in a language they understand and present your ideas for therapy in a way that is relatable to them. I liked his analogy of how you’d speak to a heavily tattooed powerlifter would be different to how you’d address a ballerina! It's very true in practice.

Proskewitz and I also share the same privilege of being private practitioners. We aren’t limited to how long we can spend with our patients to fully get to know them, listen to their histories, examine them and come up with a plan of action, and start some hands-on treatment. With osteopathy, we consider every patient as an individual, and through the biopsychosocial model, realise that they are more than the sum of their parts, so to speak. Treatment is always tailored to the individual, as are exercises and rehab suggestions.  Of course, we aren’t cheap – that has always been on my conscience as lack of finance has always been a barrier to healthcare, however, frankly, sorting out society's inequalities is not my problem!  On the other side of that though is usually a much more motivated patient. They do want to get better, to get back to their normal lives and activities, but here, management of expectations is hugely important. Just because you can throw money at it, doesn’t mean you are guaranteed success!

Other parts of this module included the psychological management side to pain management – useful techniques, and of course, is helpful in guiding patient expectations to achieve a realistic outcome. I have recently used my newfound skills to help a man who presented in extreme pain after a lifting injury at work. The onset was over a year ago, yet he was still in agony. His scans were all negative, there was nothing ‘medically’ wrong with his spine. He had had some cursory physio but was given very little advice, only a prescription for strong painkillers. I was able to spend time with him and explain why he was still in so much pain when the original damage had long healed. I was also able to give him a little hope that he could indeed get better. We started with exercises he could do in a chair, and to his amazement, he was able to do them well. I hope that by building his confidence in himself and his body’s abilities, he will get back to a fairly normal pre-accident state. I don’t think I could have spoken or acted in the way I did before doing this and the preceding modules – I really do feel my knowledge and confidence as a practitioner have grown and developed.