CT Nothing has changed...

[nari]

In our local paper today there was a two page report on our pain clinic at the hospital and its programs.

Nothing has changed over the years since I left. The emphasis remains on motor control, graded exercises (with theraband!!!) core strengthening and bouncy balls. No mention of pain education, a passing reference to neuroplasticity and lots of photos in The Gym.

The patient in focus reported she can now walk for 15 minutes before pain becomes intolerable; she has been there since NOVEMBER 2010. The waiting list is 18 months, due to staff shortages, and if they hang on to their patients for 9 months or longer - no wonder.

Can anyone tell that I am very cranky that people like Moseley and Butler are still being ignored??

Sorry for the rant..

Nari

[Barrett Dorko]

They sound no more advanced in their thinking than the therapists I work beside.

[Bas Asselbergs]

nari, you've got every right to be cranky. It is criminal.

An anecdote from my experiences with a local "pain clinic".

Patient has been getting nerveblocks weekly for 15 months - from a doctor whom I have sent copies of articles by Mosely, Shacklock, etc to. To no avail.
Morphine gets adjusted, other drugs get constantly "tweaked" and no - absolutely NO effort is made to try and support my efforts to get out of the tissues and into the behaviour, brain, motion, goal setting, graded activity, etc etc.
I do my best, and the next day she gets an injection in all the "sore spots that cause her pain".

BTW, in his pain clinic there is NO social worker or psychologist, OT or PT. Just him and his doses of mesodoom-stuff.

[gilbert]

Nari - That is disturbing. One would think that at least in a Pain Clinic there would be a lot of interest in a current understanding of pain, and in educating patients about it. Are they supposed to be providing multi-disciplinary care for persistent pain? The Aust Pain Society guidelines for Pain Management Programmes recommends four components:
-CBT Programme (aimed at unhelpful beliefs, behaviours, and emotional distress)
-Graduated Activity Programme
-An Education Programme (talks specifically about pain ed)
-Lifestyle Modification
Especially because it is so hard to get into such programs, it is a real shame if they are not offering effective help.

[Jon Newman]

The American Pain Society bestows a Clinical Center of Excellence in Pain Management award to centers that meet certain criteria. I don't have any knowledge how these clinics compare to what you're describing Nari. If such a thing exists there, maybe patients could be made aware of their existence.

I almost always ask patients who get admitted to our hospital and who also go to pain clinics what their experiences are like. It's rare that I've heard a good report but the reasons/examples for such a negative report are very diverse.

[nari]

Bas,

That sounds atrocious but so much depends on the MO's quality of care and definition of same. We had an excellent specialist at one time, who even took himself to a Butler course and loved it. He left after a year, unfortunately, for reasons of family issues.

Gilbert,

The program is, as far as I can tell, roughly conforming to the APS guidelines; what seems to be missing is correct information on pain. The PT spoke to the reporter and seemed to emphasise "we can't fix your pain" but it came across as "you have to learn to live with it".

Jon,
The organisation sounds just that - well organised. Hard to tell from a promo, but it appears to be good.

There is one part-time MO, one part-time psychologist, fulltime PT, no OT and three nurses who talk about pain and coping with it. It's unbalanced but lots of HPs see the pain clinic as a "chronic pain place" and avoid it like the plague.

Quote from the PT:

There's a pretty good evidence-base that since people have had unrelenting pain for more than 3-6 months it is not going to go away.

Arrrgghh!!

nari

[Jon Newman]

Originally Posted by nari

"we can't fix your pain" but it came across as "you have to learn to live with it".

Would it be fair to say "We can't fix your pain (in those cases where it's true), you have to learn helpful ways not to be in it or so much of it. And we can help you do that"?

[garydiny]

Maybe they should do some reading of Sports Illustrated. Found these links and thought they were pretty good for a mainstream sports coverage magazine. First one on pain science

http://sportsillustrated.cnn.com/vau...8954/index.htm

second one on CNS process in sports...pattern recognition and anticipation
http://sportsillustrated.cnn.com/vau...8950/index.htm


Gary

[byronselorme]

Originally Posted by garydiny

Maybe they should do some reading of Sports Illustrated. Found these links and thought they were pretty good for a mainstream sports coverage magazine. First one on pain science
http://sportsillustrated.cnn.com/vau...8954/index.htm

I thought that was a pretty good article. This quote about Melzack has me wondering if the Spider is a good analogy? I like it, but I am trying to find a way into to understanding the "Neuromatrix" better and I don't want this to mislead me.

If the nerve fibers compose a web in the body, the brain is the spider at the center, using the web as a data-collecting extension of its body. Each vibration of the web reveals the location and size of the intruding sensation and sets other strands vibrating that the spider must collectively interpret to decide on a course of action. And just as experience in the wild teaches the spider to become an increasingly savvy decision maker, so does experience act upon the brain. Among Melzack's revelations was that part of the brain's hardware is what he called a pain "neuromatrix," essentially a blueprint of a full body that exists in the brain whether or not the full body exists in physical space. But to interpret the sensation of pain, he found, the brain has to install specific software.

[Diane]

Not a bad analogy, actually, the spider idea.
The brain is a predictor and a simulator (Buzsaki). It mostly overlaps its predictions with its body representations and inputs and outputs quite seamlessly. When it doesn't, well, even monkeys fall out of trees sometimes.

[byronselorme]

Originally Posted by Diane

When it doesn't, well, even monkeys fall out of trees sometimes.

Now that is good

[nari]

Jon,

I agree, but as it was reported in the paper, it sounded rather negative; although going to the other extreme would be worse!

Gary,
Thanks for those links. Will read them a bit later.

Nari

[nari]

I just came across this site:

http://www.specialistpainphysio.com/

I think it is gratifying that some health professionals have got it right.

Nari

[Sheffphysio]

Originally Posted by nari

I just came across this site:

http://www.specialistpainphysio.com/

I think it is gratifying that some health professionals have got it right.

Nari

Good old UK physio's!!

I wish the site you showed was the norm in the UK, it's not.

We are really good a crushing hope. "you'll never get any better, here have some management strategies"

[nari]

Dave, if the aforementioned site was the norm, you guys would be renowned (perhaps) throughout the physio world and the world would flock to the UK.

Still, it is good to see glimmers of light in the ocean of tradition.

Nari