My approach to pain management, lessons and reflections from experience

Chronic pain affects millions of people globally, often turning everyday tasks into challenges. This condition can arise from various sources, including injuries, diseases, or even emotional stress. For years, I have attended to multiple cases who presented to the hospital due to a flare up of their chronic pain. Admittedly, this is not something that my physiotherapy training has prepared me adequately for and I must have inadvertently made things worse for my clients despite having good intentions like all of us working in the field of health do. In this post, I want to share my journey, reflections and insights on navigating the challenges that come with chronic pain.

Chronic pain is not just a physical struggle; it's an experience that impacts emotional and social well-being as well. It affects millions globally and here in Aotearoa, 1 out of 5 Kiwis experiencing chronic pain in their lifetime. As a physiotherapist in New Zealand specializing in this area, I have met many incredible individuals. Each has a unique story and a distinct challenge. In this post, I will reflect on my experience managing chronic pain and emphasize the importance of a holistic approach that incorporates the biopsychosocial model.

Understanding Chronic Pain

Chronic pain is characterized as pain that lasts for more than three months. It can manifest in different ways, including musculoskeletal pain, neuropathic pain, and pain associated with conditions such as arthritis or fibromyalgia. However, not all pain begins with a dramatic event; sometimes it arises from something as simple as lifting an item from a car trunk or sleeping in an awkward position one night.

Pain is essentially a very important function without which we won't do very well. Pain warns us of potential danger or damage to our body and it is only right to pay attention to it. The challenge with chronic pain, however, is that the pain often feels disproportionate to the original injury or persists long after the body has healed. For those living with it, the frustration can be immense — why am I still in pain when everything seems fine? Having to explain this to loved ones adds yet another layer of difficulty. The sense of doubt or not being fully understood can, in itself, make the pain feel even worse.

The biopsychosocial model is vital because it shows that biological, psychological, and social factors all contribute to pain perception. I have discovered that focusing solely on the biological aspect of pain is insufficient, as it often overlooks other influencing factors. It's crucial to address not only the physical symptoms but also to consider emotional and social factors, resulting in a more comprehensive treatment approach.

A Thorough Examination

A thorough assessment is always the first step in my approach. I look beyond the physical symptoms to consider each client’s medical history, lifestyle, and psychosocial factors. This broader perspective often reveals underlying contributors that may have been overlooked. Chronic pain can sometimes persist because clinicians, myself included, focus too narrowly on one aspect of the problem. As humans, we all have blind spots — and it’s crucial to reflect on past experiences, learning from what worked and what didn’t throughout the treatment journey. Sometimes, all it takes is a second pair of eyes to uncover the missing piece of the puzzle!

During the session, we will go through not just the physical examination but also a detailed history of what has transpired. I am lucky to have practiced alongside numerous great clinicians that has thought me heaps about holistic healthcare. Together, we will discuss the other components of health (diet, sleep, other biomarkers) which might be impeding your recovery. I also aim to work with your GP or specialist to get to the crux of the issue so that we can achieve the best results collectively.

Exploring the Psychosocial Aspects of Pain

I guide my clients through understanding the psychological drivers of their symptoms. This can include discussing their feelings regarding pain, past experiences that affect their situation, and their social support networks. I also welcome family members and support people to attend the sessions together

Working together with loved ones usually gives the best results

Gradual Challenges for Improvement

Gradually challenging clients is integral to my approach. This involves setting realistic, achievable goals tailored to each person's unique situation. Research supports that small, incremental changes can lead to substantial improvements over time.

For instance, if a client struggles with mobility, I might start them on gentle exercises focusing on range of motion. Over weeks, we might progress to strength training when they're ready. This cautious, supportive method builds confidence and fosters resilience, enabling clients to regain control of their lives.

The Importance of Education in pain management

Education is crucial in chronic pain management. Many clients have misconceptions, believing movement or certain activities will worsen their condition. I found that this is often due to previous negative experience reinforcing the pain response. It is normal for humans to have a strong response to negative experience due to the innate preference for self perseverance. Our pain and fear centers often gets calibrated by past traumas so that we don't hurt ourselves again. By understanding this mechanism, we can work towards desensitizing or toning down our pain response to stimulus and with time, aim towards recovery.

I utilize visual aids and handouts to explain the mechanisms of pain, highlighting that active movement is frequently advantageous. By debunking myths, I assist in alleviating fear and anxiety, empowering clients to take charge of their health. I also believe that clients should guide this process of pushing boundaries, and I've observed the best outcomes when clients determine how much to challenge themselves.

Building a Supportive Environment

Creating a supportive environment is essential for effective pain management. I encourage clients to involve family and friends in their rehabilitation journey. Studies show that patients with robust support systems report better adherence to treatment plans and improved outcomes.

I also collaborate with other healthcare professionals, such as psychologists, to provide a well-rounded approach. This teamwork ensures we address all aspects of a client’s well-being, ultimately leading to better results.

Reflecting on My Practice

As I look back on my journey as a physiotherapist, I am continually inspired by my clients' resilience. Each person brings their unique experiences and challenges, and it is a privilege to accompany them on their healing journey.

I’ve learned that managing chronic pain is not simply following a set protocol. It requires flexibility, empathy, and a commitment to understanding each person. By embracing a holistic view and the biopsychosocial model, I strive to deliver the best care possible.

Moving Forward with Hope

Managing chronic pain is a multifaceted process. Through thorough assessments, addressing psychosocial factors, setting gradual challenges, and educating clients, I aim to empower individuals to manage their pain effectively and enhance their quality of life.

I remain dedicated to evolving in my practice, learning from my clients, and adapting my methods to best support their needs. Together, we can face the challenges of chronic pain and move toward a brighter, more fulfilling future. Give us a call to see how we can help.