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A clinical resource to help manage chronic pain

Chronic pain, one of the most common and costly global health problems, can represent a substantial challenge for both patients and clinicians. Goal setting with patients, considered a “Best Practice” activity is a clinical practice inherent to chiropractic care and other health professions. However, there are relatively few resources to assist clinicians with helping set and achieve treatment goals, recognize barriers, and measure success for patients suffering from chronic pain.

A recent article published in the journal Physiotherapy Theory and Practice details some challenges clinicians encounter when facing chronic pain in clinical settings.[1] The article also describes many important considerations for clinicians helping patients manage with chronic pain. Below are several quotes from this article.

“Related to the process of setting and achieving goals, functional brain imaging [of patients with chronic pain] has demonstrated impaired activation in neural networks responsible for attention, concentration, and learning.”

“Long-term opioid therapy may also be a factor in [hypothalamic-pituitary-axis] HPA dysregulation, as well as contributing to cognitive deficits including executive function, spatial memory, working memory, and flexibility for conceptual change.”

“…management advice … more often mirrors the pain beliefs of the clinician rather than adapting to the perspective of the patient. “

“Clinicians with strong biomedical pain beliefs tend to provide management advice in contrast to practice guidelines such as recommendations for rest and avoiding activities which may cause pain.”

“As clinicians share a social responsibility to foster societal health and wellness, it is important to recognize that incorrect advice to individuals may have potential to impact inappropriate pain beliefs…”

“When developing goals and plan of care, clinicians should consider potential contributions from the social network in the therapeutic equation.”

“Persistent pain has the potential to alter cognitive processes making it difficult to set goals and adhere to a self-management program. Furthermore, if pain-associated changes in cognitive functioning remain unrecognized the clinician will not implement management strategies to successfully guide a patient through the rehabilitation plan.”

In addition to describing the many complex components associated with chronic pain, the article includes substantive suggestions for clinicians in setting and achieving collaborative goals with patients. This article is a valuable clinical resource clinicians can use to improve their knowledge and skills when helping patients manage chronic pain.

Reference List
1. Schmidt SG: Recognizing potential barriers to setting and achieving effective rehabilitation goals for patients with persistent pain. Physiother Theory Pract 2016, 1-12.

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