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Why are we so bad at treating chronic pain?

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  • #31
    Originally posted by Johnny_Nada View Post
    Here are a few thoughts Gilbert:

    Ignorance and over-confidence (cynically speaking: bias and incentive)

    Maybe we should demand more from healthcare professionals, researchers, authors and publishers to make the evidence and decision making "crystal-frigging clear" for the public. No spin, no BS. Here's an idea: openly publish and educate the exact findings from the research and our currently knowledge.

    This is my problem with current published research. I think it is labled wrong. Instead of Purpose - Hypothesis - Materials - Procedure - Results-Conclusion. I think it would be better if it was
    Purpose- Material- Procedure - Results - Hypothesis. I think we make a lot of assumptions in reaseach that just because results backed up our initial Hypothesis that it has proven the authors theory. But the conclusions are often biased to the ideals of the author and are limited to the knowledge base that the researcher have access to. Then people take that conclusion as fact to reinforce their beliefs. Labeling it Hypothesis would allow the author to explain his theory on what happened during the experiment and frame future research on the topic. It may prevent some of this but will sell less journals, so it will never happen.


    • #32
      Originally posted by Johnny_Nada View Post

      It reminds me of the picture showing two theaters: one is showing an inconvenient truth, the other a re-assuring lie. Guess what theater has a line out front? We can't be afraid to provide the inconvenient truth and public needs to accept it. Otherwise they'll continue standing in lines...
      Why can't we also have a Reassuring Truth. Do we have to be so crass as to say "pain is normal" and "deal with it". While that may be what some people need to hear, for others it may drive them to the reassuring lies that we are trying to avoid. Where is the empathy there? Where is the acceptance of our patient's beliefs? If we tell everyone that comes through our door that "Pain is normal" and " Deal with it" most patients are going to see us as just another health care provider that is dismissing them and their beliefs. Even if their beliefs are wrong, you must at least acknowledge them. If we are talking about de-stigmatizing pain and reducing fear I am all for it, but there is a big difference between that and "pain is normal" and "deal with it".


      • #33

        I'm not suggesting we be crass in the message or tone. It comes off that way here because I'm communicating with individuals (I think) able to handle the discussion. My interaction with patient would be best described (my attempt, but maybe not wha the patient perceived) as a "re-assuring truth." I'm not too certain people with persistent pain want to hear that either. Is it even possible to give a patient with persistent pain a "re-assuring truth" message? A common response I've received was "I know this won't kill me, harm me, injure me, whatever..I don't care...I just want it to go away!"

        I'm still trying to figure out and understand how patients with life changing/altering/ruining circumstances compare to individuals with pain. These folks have been given a diagnosis and prognosis that is concrete and final in many cases.

        The person with a stroke without restoration of function
        The person with a cervical myelopathy with permanent loss of function/balance/etc
        The person diagnosed with MS/PD/insert neurological condition
        The person with a spinal cord injury
        The person losing a limb.

        How/why is it, these individuals self manage, modify, "deal with it?"

        Is it they've accepted things? Is it pure resilience, since hope is lost for full return? Do they have an uncanny ability to find hope elsewhere, that many with persistent pain cannot? How do we promote that?
        "The views expressed here are my own and do not reflect the views of my employer."


        • #34
          Dosage of pain rehabilitation programs: a qualitative study from patient and professionals’ perspectives


          Multidisciplinary Pain Rehabilitation Programs (PRPs) are recommended to treat patients with chronic musculoskeletal pain (CMP) [1, 2]. These PRPs, based on the biopsychosocial model, aim to decrease disability and optimize participation of patients with CMP. A systematic review showed that PRPs have a moderate, but consistent, positive effect on disability and pain, compared to usual care or physical treatment programs for patients with chronic low back pain [3]. PRPs result in better self-management of pain and disability, and a reduction in healthcare utilization in treated patients was found, which may contribute to a decrease of direct and indirect costs over the long term [4].

          Although effective, PRPs are relatively expensive. The multidisciplinary characteristics, as well as the high number of contact hours and total duration of PRP, provide relatively high direct costs and travel expenses for the patients. Dosage of PRP includes the total duration, the total number of contact hours, and intensity of treatment (number of contact hours per week). Differences in the dosage of PRP may lead to differences in direct and indirect costs. Choices for dosage and how dosage is established for an individual patient is unknown. A recent systematic review showed that dosage of PRP has never been studied as a primary aim and the optimum dosage of PRPs is currently unknown [5]. The studies included in that review differed in terms of dosage (total duration, from weeks to months, and regarding contact hours, from fewer than 10 to over 100 h) and effect.

          Better understanding of variables that are taken into account when deciding for a particular dosage could lead to better and more efficient patient care, which will benefit patients, rehabilitation facilities, insurers and employers. This study aimed at exploring perspectives of patients and rehabilitation professionals to acquire insight into factors that may contribute to dose choices of multidisciplinary outpatient PRP. In addition, this study aimed at examining the argumentations underlying choices in dosage of PRPs in three rehabilitation centers in the Netherlands.
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi