Pain management programmes

[JimA]

I am in the process of setting up a physio led pain management programme but I am not sure of the best way to include the exercise component. Anyone know what format works best?

[Kriskul]

Tough question. Do all your patients need the same exercise format? What variables do they need to improve? Are you thinking of generic reconditioning?

[Luke Rickards]

Have you reviewed the current literature? If not, that would be the best place to start.

[JimA]

To be more specific about this group programme. Is it better to have a set circuit of functional exercises that patients work on at their own pace or individualise the exercise programme?
Should the exercise be in short bouts interspersed by the education or after the educational element.
What about some of Butlers active neural movts. rather than general fitness work?
Does it really matter as long as the patient gets moving?
I realise there may be no definate answer to this but what have people found from their experience?

[Diane]

How about ask the patient to breathe, move slowly, and sense their bodies as they move. Then they can move however they would like. (This is for a pain clinic, right?)

[nari]

Jim,

I think Butler's movement suggestions would be a good start.
What I found personally that people like the sinuous, smoothly executed movements a la Butler. So do their nervous systems.

Once they have the idea, encourage them to make up their own. Music is always useful, and probably fairly rhythmic.
I don't think aiming for fitness is appropriate; just let them go with the flow; fitness can come later once their nervous systems are coming off red alert.

Keep it simple and let each person develop his/her own thing if they wish. The crucial thing is movement, but it is far better if it is their movement.

Nari

[Randy Dixon]

Like Diane, I would suggest some sort of sensory awareness class. I'm not sure if it is important what form or name of this you use. Although an already existing program may make it easier for you.

[Luke Rickards]

Jim,

This editorial (http://www.somasimple.com/forums/showthread.php?t=4588) may be useful to you. I was particularly drawn to -Finally, it should be kept in mind that there is sufficient evidence that physical treatment is effective (Hayden et al., 2005). However, there is increasing evidence that reconditioning itself is not the mediating process, but the reduction of pain related fear and pain catastrophizing.

[JimA]

Thanks for all the suggestions. Unfortunately Luke I am not able to access the editorial.
I asked the question because all pain group programmes I have read about seem to use general exercise, stretching and aerobic exercise and reading this site many suggest stretching and fitness exercise may not be the way to go.
This group is not linked to a pain clinic it is based in physiotherapy dept. and will progress to community based clinics/ health centres, mainly for moderate to severe chronic pain patients with no major psychological distress.

[Adiemusfree]

Thanks for all the suggestions. Unfortunately Luke I am not able to access the editorial.
I asked the question because all pain group programmes I have read about seem to use general exercise, stretching and aerobic exercise and reading this site many suggest stretching and fitness exercise may not be the way to go.
This group is not linked to a pain clinic it is based in physiotherapy dept. and will progress to community based clinics/ health centres, mainly for moderate to severe chronic pain patients with no major psychological distress.

The programme developed by Mick Sullivan out of Canada (the PGAP and PDP) essentially uses exercise as a means to reduce avoidance based on fear of movement and pain; as an operant approach to rewarding well behaviour and as a general re-engagement in life activity. I haven't found many people with moderate to severe chronic pain who don't have psychological distress in my years of practice, but if you have some then the PGAP approach may be quite useful although it's been developed for subacute pain.
Another option is to forego exercise per se and run with activity which can include general activity such as walking, swimming, dancing, cycling, playing golf, kicking a ball around, playing on the Wii, even line dancing! I think one reason pain management programmes have been keen on including exercise is that it has great face validity, supervised exercise means the person believes they are being 'prescribed' the 'right kind' of exercise, and this reduces anxiety and increases adherence to actually doing it.