New Here... aren't most people who post in this section? :)

[Randy Dixon]

Hi Curious and welcome.

I too am a massage therapist. Karen lines (another MT) gave some good advice in post #13. Take your time, give yourself time.

It'll kind of go like this :

:angry:, :cry:, :sad:, , , , and finally

:teeth:

Happy reading.

How long until you get to the third face? It's been 6 or 7 years for me.

[John W]

If they only want chiropractic, then that is what they will get. If they choose both chiropractic and bodywork, then I'll incorporate those as needed for their particular situation. But, if someone only wants soft tissue work, then soft tissue work is what they will get.

So the patient dictates what their treatment will be? I would be concerned that this approach might hamper clinical reasoning.

In any case, it sounds like you "work on" people. I've moved away from the "operator model"- as it is often referred to on this board-mostly because much of the research on chronic pain recovery identifies restoration of an internal locus as a key to long-term improvement in pain and disability. No manual, exercise or CAM approach that I'm aware of has been shown to have a significant long-term effect on outcomes for patients with persistent pain problems. If anything, the problem is getting worse.

As I heard Barrett Dorko say recently, "They're not calling it a neurobiological revolution for nothing," or something like that.

In the short term, no doubt, many manual techniques that meet the expectation of the patient will provide results, but I worry that relying on this approach to care turns patients into long-term patients, not people with long-term relief from their pain.

This approach has its benefits, not the least of which is a steady stream of reliable return patients. It also makes us feel good about ourselves for "helping people".

See here for more on the operator versus interactor model of care.

[proud]

How long until you get to the third face? It's been 6 or 7 years for me.

Depends on how dedicated you are to figuring it out. If you just read little chunks here and do not dig into the bulk of the literature referenced...I suspect you will not move forward very fast.

FYI...I figure I'm at . Still trying to figure out how I apply what I know to be true, in a healthcare environment that is utterly broken where volume of patients seen is championed and truthful approaches viewed with disdain and often....anger.

Ahhh death. I'm certainly not :teeth: with it yet....

[Barrett Dorko]

Yes John, I was wondering about allowing the patient so much input into method. Heck, I can manipulate anything, and at one time I taught others. I will; never do that to another again.

I think the idea of a toolbox has been addressed here.

[proud]

In the short term, no doubt, many manual techniques that meet the expectation of the patient will provide results, but I worry that relying on this approach to care turns patients into long-term patients, not people with long-term relief from their pain.

This approach has its benefits, not the least of which is a steady stream of reliable return patients. It also makes us feel good about ourselves for "helping people".

Ah John..always putting words to my thoughts with such clarity. I actually attempted to relay this message to a therapist the other day.

It didn't go well.

[Curious One]

So the patient dictates what their treatment will be? I would be concerned that this approach might hamper clinical reasoning.

In any case, it sounds like you "work on" people. I've moved away from the "operator model"- as it is often referred to on this board-mostly because much of the research on chronic pain recovery identifies restoration of an internal locus as a key to long-term improvement in pain and disability. No manual, exercise or CAM approach that I'm aware of has been shown to have a significant long-term effect on outcomes for patients with persistent pain problems. If anything, the problem is getting worse.

As I heard Barrett Dorko say recently, "They're not calling it a neurobiological revolution for nothing," or something like that.

In the short term, no doubt, many manual techniques that meet the expectation of the patient will provide results, but I worry that relying on this approach to care turns patients into long-term patients, not people with long-term relief from their pain.

This approach has its benefits, not the least of which is a steady stream of reliable return patients. It also makes us feel good about ourselves for "helping people".

See here for more on the operator versus interactor model of care.

I guess you could say the patient dictates in the quest for a specific type of care, because I do want them to be active in their care, and that is why I am open to the patient letting me know the care they are interested in, but, it does not mean that I won't give my opinion as to the best way to treat (in my experience). And, most patients are open to my recommendations. However, I am not going to refuse care (unless there is a specific contraindication) if I think I can create another plan of action that will still generate positive results.

Some of these suggestions regarding active care may come from me, some may come from other practitioners I refer the patient to (as noted previously regarding Applied Functional Science and Feldenkrais practitioners I refer to).

I also believe if a patient is better and they no longer have pain issues, then I have done well. It happens frequently. Then, new people invariably take their place at some point or other.

My practice is not all chronic pain issues. Some have pain due to specific issues that get resolved.

And on the occasion when I have someone who is not interested in taking their health into their own hands, I will provide palliative care as requested. Generally those tend to be bodywork clients who have personal stress issues.

BTW, thanks for the link.

[Diane]

And on the occasion when I have someone who is not interested in taking their health into their own hands, I will provide palliative care as requested. Generally those tend to be bodywork clients who have personal stress issues.

I suppose this pertains to the chiropractor definition of palliative care, because I seriously doubt you'd be qualified ( as a non-medical human primate social groomer) to provide medical palliative care.

[Curious One]

I suppose this pertains to the chiropractor definition of palliative care, because I seriously doubt you'd be qualified ( as a non-medical human primate social groomer) to provide medical palliative care.

You would seriously be correct. I am in no way qualified to provide medical palliative care.

Such a poor choice of wording on my part.

I should have said... In those instances I will provide care which consists of working to relieve pain or tension, in order to make the patient/client comfortable and improve their quality of life.

[HeadStrongPT]

If I can offer a recommendation at this point. CO has introduced himself...at this point I don't believe it too bold an assumption to assume he is a he.

It looks as though CO has enough posts to get into the Sounds of Silence. If he were to trick around there and read some old posts/threads, I believe there would be a better chance of this not being the last thread on which he participates here.

[Diane]

You would seriously be correct. I am in no way qualified to provide medical palliative care.

Such a poor choice of wording on my part.

I should have said... In those instances I will provide care which consists of working to relieve pain or tension, in order to make the patient/client comfortable and improve their quality of life.

No prob. It does reveal a tendency I've noted before, though, that chiropractic likes to impersonate the medical profession a lot, including using all the same words but bestowed with untraceable, chiro-only meanings.

[Greg Lehman]

Hi john,

. No manual, exercise or CAM approach that I'm aware of has been shown to have a significant long-term effect on outcomes for patients with persistent pain problems. If anything, the problem is getting worse.

Do you have any research showing a robust, long term positive effect for ANY intervention for persistent pain problems? We are far from establishing long term and powerful improvements with the treatments within the neuroscience revolution framework.

Greg

[Curious One]

No prob. It does reveal a tendency I've noted before, though, that chiropractic likes to impersonate the medical profession a lot, including using all the same words but bestowed with untraceable, chiro-only meanings.

Actually, it was a personal perception, that was poorly misplaced. I am not sure I have ever heard any chiro-specific wording to that effect.


I use palliative to mean:

pal·li·ate
   /ˈpæliˌeɪt/ Show Spelled[pal-ee-eyt] Show IPA
verb (used with object), pal·li·at·ed, pal·li·at·ing. 1. to relieve or lessen without curing; mitigate; alleviate.

[Diane]

Hi john,



Do you have any research showing a robust, long term positive effect for ANY intervention for persistent pain problems? We are far from establishing long term and powerful improvements with the treatments within the neuroscience revolution framework.

Greg

Work by Moseley has shown the best long term outcomes are associated with pain education. The difference between pain ed and other kinds of interventions don't show up at first. At first all seem about as effective or ineffective. The trend lines really start to move apart at about 6 months down the road. This is old stuff, about 8 - 10 years ago.

[Curious One]

If I can offer a recommendation at this point. CO has introduced himself...at this point I don't believe it too bold an assumption to assume he is a he.

It looks as though CO has enough posts to get into the Sounds of Silence. If he were to trick around there and read some old posts/threads, I believe there would be a better chance of this not being the last thread on which he participates here.

My mistake for not pointing it out, although it was mentioned in this thread previously. I am a female.

And, yes, I do agree that it is getting close to the last thread I participate on at the rate this is going. I am wondering why people are even invited to join, at this rate.

The forum might be better off in stating... please... leave, in their welcoming pages.

[Diane]

People just turn up here, most of the time.