As health practitioners, we often talk about the journeys that people have come on when experiencing persistent pain. We take note, listening to their story, trying to understand the struggles, the ups and the downs, the people they’ve met along the way and commonly hear the often differing and conflicting information provided by health professionals. Individuals with persistent pain attend with a variety of emotions, hoping that we can help try and piece together the pieces of their pain puzzle, and help guide them along their journey. The stories are all too familiar.
As a physiotherapist working for almost 20 years, working with people with persistent pain, I have had time to reflect on my journey, and similar to many people with persistent pain, there have been highs and lows, moments of confusion, periods of clarity, times of feeling disheartened and more importantly, times of fun and joy. In recent times, through social media, I have observed the many discussions around how the pendulum is shifting from a biomedical approach to a more biopsychosocial, person centred approach. This is interesting, as it mimics the change in practice for me as a musculoskeletal practitioner.
In my early musculoskeletal years, the interactions with patients mimicked my training. My role was to assess, diagnose, treat and get people better using a biomedical model. Simple! The concept of not getting people better was not a consideration and was never really discussed. On the occasions the outcomes were not favourable, the manual techniques were pushed to their limit, the electrotherapy dials were turned up and the exercises got tougher! And if then, and only then, the patient wasn’t better, they were left with nowhere to turn.
As my career progressed, I was thrust into the world of persistent pain, and I must admit, this was with a little hesitation and scepticism. Surely, this isn’t proper physiotherapy! Looking back now, how wrong I was. I was incredibly fortunate to be embraced by a team of passionate, highly driven clinicians, eager to make working in the area of persistent pain exciting.
Working with individuals with persistent pain, it soon became apparent how rewarding this area of work was going to be. The moment a patient returned, excited that they had discovered what opened and closed their ‘pain gates’ creating the first real moment of feeling in control. The distressed patient attending in so much pain, that the previous biomedical model would have struggled to know what to do, provided the patient with space, time and reassurance to allow the distress to ease. This was rewarding, in a way I hadn’t even contemplated.
My approach to rehabilitation has significantly changed, utilising contemporary pain science, psychologically informed principles and exercise that is delivered in a way that is meaningful and fun, and less clinical.
Over the years, working with individuals with persistent pain has become an area of particular interest. As clinicians, we often expect patients to make changes, and working with people with persistent pain helped me understand, that clinicians too have to change. I no longer consider myself “the expert” in fixing an individual. The individual is the expert, and I am merely someone joining them on their journey, offering tools and guidance to help them achieve their goals.
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