Reflecting on Chronic Pain Management

Last week, I was reading the most recent JOSPT's editorial on chronic pain: "When Chronic Pain is Not 'Chronic Pain': Lessons from 3 Decades of Pain." While an editorial (and the case study presented within it) is not a standard for evidence-based practice, the article does an excellent job of stating that just because we think something is correct today, doesn't mean it will be in 10 years. If you aren't familiar with the article, a case is presented on an individual that had leg pain over 3 decades of his life and was treated with the different "fads" of each decade: McKenzie, core stabilization, and more recently pain science. The individual in the case study showed little change in his symptoms until an exercise-based ABI was performed and revealed circulatory issues in his LE. Once the vascular issue was addressed surgically, the individual was back to his PLOF from 30+ years ago. 

​Obviously, a case study doesn't hold much weight by itself, but this article does an excellent job of getting us thinking about the state of physical therapy and our overall perception of evidence-based practice. At each point that care was being delivered to the individual, the treatment was perceived as best practice. Today addressing pain science and biopsychosocial aspects is the more evidence-based treatment. If anything, research today should tell us that there is a lot out there that we don't understand, and we are prone to blindly attribute the effects to the nervous system or the mind in general. As the author of the article stated, it will be interesting to see in 10-20 years how the practice of PT changes. While we should absolutely base our treatments in what the evidence suggests while practicing, we shouldn't be so quick to stop researching other techniques that may prove beneficial down the road as we continue to learn more.

​-Dr. Chris Fox, PT, DPT, OCS

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