Winter 2021 Balancing the pain factor

Contents

Living well with fibromyalgia: a case study to explore person-centred management

Fibromyalgia is a debilitating, multifactorial condition that can be difficult to manage. The mechanisms and management of fibromyalgia are discussed through the use of a linked case study, with emphasis on improved physical activity levels. Pain and fatigue can decrease motivation and affect adherence to exercise, and emotional distress may act as a barrier to rehabilitation. A collaborative approach helps individuals build the strength to cope with the challenges of living with this complex and disabling chronic pain. This article discusses the safe and appropriate use of medication, together with techniques that enhance the therapeutic alliance to meet this challenging condition.

Leila Heelas 

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The missing pieces of the pain puzzle: a personal account about discovering the mind-body approach to resolving chronic pain and restoring wellbeing

Chronic pain therapy is often aimed at palliating local tissue symptoms or teaching patients pain coping strategies, rather than aspiring to resolve the pain. In contrast, the mind-body approach makes sense of “medically unexplained” symptoms and informs the clinician of treatment strategies aimed at addressing the root causes of pain; emotional repression and stress-induced dysregulation of the autonomic nervous system (ANS). A mind-body diagnosis is good news for the chronic pain sufferer because this condition is benign, treatment strategies are self-empowering and full recovery is often possible. This holistic approach is supported by research and recent discoveries in the field of neuroscience, thereby adhering to our professional code of practising evidence-based treatment. It is exciting because neuroscience and psychology converge to create a universal explanation that can unlock the complex puzzle of chronic pain

Irralee Andrzejowska

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Pelvic pain: the inside story

This article considers the complex area of pelvic pain with a specific focus on urinary chronic pelvic pain syndrome (UCPPS). It discusses the concept of perceived threat in the generation of pain, the connection between low back pain and pelvic floor dysfunction and the importance of taking a biopsychosocial approach to the assessment of pelvic pain and explores the use of questionnaires designed to provide an assessment of the psychosocial components of the patient’s pain. Consideration is given to the validity and reliability of the palpatory assessment of the pelvic floor muscles and, with the use of a case study, the author will show practical application for a patient who presents with UCPPS.

Bill Taylor

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How does menopause affect musculoskeletal pain? Implications for physiotherapists

Menopause can be a challenging time, which most women may have to go through at some point in their life. Musculoskeletal pain(s) is one of the first potential symptoms and, as such, should be recognised by clinicians. The effect of reduced oestrogen can significantly impact on pain intensity, including exacerbating current joint problems, and intensifying pain levels. Conversely, it can also affect healing rates of muscles, tendons, nerves and joints and be a trigger for tendinopathies. This may have a profound effect on our management and prognosis. Also, if left unmanaged, menopause itself can lead to other more serious health related issues, which remains important for clinicians and therapists to educate and refer on where appropriate for early management.

Solomon Abrahams

Beth Sheehan

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Persistent pain: kicking the habit

This article introduces the idea that unconscious habits can lead to persistent pain development; a habit that occurs beyond the individual’s awareness and is never their intention. Understanding that mechanism of the belief system of a person who is convinced that they have structural, tissue-based pathology or damage causing their pain, can remove the fear underpinning the automaticity of thoughts, breathing patterns, movements and feelings involved in the persistent pain cycle. It can also help to identify how to support the patient in taking responsibility for their own recovery, and how habituating new behaviours can lead to pain reduction and perhaps result in a life free from persistent pain (Ashar et al 2021).

Drew Coverdale

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Pain self-management and the skill of pacing: a first choice or last resort

For many people with persistent pain, self-management is only offered to them as a last resort, and when the usual medical pain management approach has already been exhausted. From the patient perspective, the self-management option needs to be offered to the individual with persistent pain way before the stage of it being a last resort.

Pete Moore

Katie Knapton

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