Chronic pain remains one of the most difficult diagnoses to treat. Over the years, various treatment styles have come through claiming to be the "fix" for chronic pain: McKenzie, core stabilization, dry needling, manipulation, etc. The current best-evidence approach incorporates much of what pain science research has revealed recently.
One of the most important concepts for managing our patient's pain experience lies in educating them about what is pain and how the nervous system works. There are an enormous amount of factors that contribute to a individual's experience: work, family, finance, and much more. Explaining to our patients how these factors can impact them is essential. While the purpose of this article is not to teach you how to educate your patients about pain, there are plenty of resources out there. We recommend Explain Pain, Therapeutic Neuroscience Education and videos like the two shown below.
Another useful component for managing chronic pain includes graded exposure. Graded exposure involves gradually increasing the tolerance to certain activities that patients are afraid will "hurt." There's a lot more to it than that, but we recommend finding an activity or function that the patient is currently having a difficult time doing, but is one of the primary goals. We want to make it so the patient is even more motivated to work towards it. Next, you find different ways to gradually increase the exposure to those activities and increase the "tolerance." For example, if your patient is having a hard time walking and that is their goal. You may challenge them to simply focus on gradually increasing their walking distance each week. Don't tell them to focus on how much pain they are experiencing. Reinforce the goal of improving their function. Another method may be to alter the actual load gradually. Walking in a pool or on a body weight supported treadmill can be useful in increasing walking and aerobic activity, while not letting the patient's pain limit them. Over time, the body weight % can be increased, so that eventually they are walking further on land.
There are many ways to address low back pain and each individual may respond differently, but patients with chronic pain can be a little more difficult to manage. Consider incorporating pain science education and graded exposure to your treatments. These patients do not typically have the same "mechanical" response as more acute cases.
-Dr. Chris Fox, PT, DPT, OCS
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