Chronic Pain Management

Our Approach

At The Good Physio, we prefer not to use the term ‘Pain Management’. It tends to project a message that persistent pain cannot be treated and, instead, patients should simply be encouraged to come to terms with their suffering and find ways to cope.

Research in clinical neuroscience demonstrates the remarkable adaptability of the human nervous system and, with a more modern, integrated programme of analysis, education and therapy interventions delivered by real experts in this field, our aim is to treat persistent pain, not just to ‘manage’ it.

Research suggests that the treatment of pain is much more effective when it is dealt with by a group of experts pooling their knowledge and working together in what we call a multi-disciplinary team or MDT. The Good Physio utilises a trusted network of specialists in this area to provide advanced level Physiotherapy including Cognitive Functional Therapy (CFT), Cognitive Behavioural Therapy (CBT), Clinical Psychology, Sleep Hygiene and Medical Management and lifestyle and behavioural change.

Please scroll down to read more. It is very likely that you have not fully addressed the issues that we can cover for you. Call for an appointment or simply get in touch to ask questions; we are more than happy to call you back and are likely to have the answers that can empower you to get your life back.

Pain Education

It is probably fair to say that we all have views about ‘how the world is’ which are not entirely accurate, and our understanding of pain is definitely one of these. Perhaps surprisingly, these inaccurate thoughts are often fuelled and reinforced by health professionals who inadvertently help to create an over-reliance on medicines and surgery as front line treatments.

A huge part of starting to feel better involves understanding what pain actually is and what it really represents. Good quality research is now showing that, even without everything else we can help with, well informed Pain Education significantly decreases pain levels in most patients with chronic pain conditions.

The Biopsychosocial Model of Pain

The biopsychosocial model provides us with a much more accurate understanding of pain (and illness) and has become accepted as the most modern and effective way to approach all patients, especially those with more chronic problems. It teaches us that pain should no longer be viewed as an inevitable set response to nerve endings that are stimulated in the part of our body we feel is hurting. Instead, pain is a highly variable brain output designed to protect us from harm and is modulated throughout the nervous system including the brain itself. It is influenced by our thoughts, beliefs, past experiences and emotions as well as social and cultural context (how it affects our lives, our relationships and careers). In fact it turns out that, particularly as it becomes more chronic, pain has increasingly little to do with tissue quality at all and steadily more to do with these psychosocial factors which encourage a now overly-protective brain to produce more pain in a continued attempt to protect us from ‘perceived’ threat.

The good news is that we are now really starting to understand how best to treat more chronic or persistent pain conditions without resorting to long term dependence on pain killers or on invasive procedures.

Mental Health & Well-Being

The relationship between chronic musculoskeletal pain conditions and mental health problems is becoming increasingly clear with the two often fuelling each other in an on-going viscous cycle. It is therefore vital that, in order to effectively treat chronic pain, we must also tackle these ‘hard to deal with’ issues that so many of us have. The World Health Organisation (WHO) suggests that depression is fast becoming the World’s leading cause of disability and around 1 in 10 adults in the UK is likely to suffer from depression at some point in their lives. This figure is likely to underestimate the true extent of the problem as many people still do not like to talk openly about mental health issues due to the social stigma associated with them.

Chronic stress and anxiety in our lives alters levels of stress hormones in the body such as adrenaline and cortisol. These chemicals which increase normally with acute stress and are, in the short term, actually useful to keep us alert when we face danger (fight or flight response), end up becoming constantly elevated. This has a profound impact on normal bodily functions such as hunger, sleep and immune system function so that we are not able to fight infection, maintain normal general health or regulate our sensory nervous system adequately.

We work using ‘psychologically-informed physiotherapy’ as well as CBT, stress management and mindfulness which all help to tackle the basic issues lots of have and teach us how to develop effective coping and management strategies. We are also very quick to recognise when there are more deep rooted issues that require the expert help of Clinical Psychology colleagues who are trained specifically in dealing with these problems.

Sleep Quality

Research shows that even one night of sleep deprivation significantly lowers our pain threshold. So just imagine what it does when pain stops us from getting good quality sleep for months or even years as it does for many chronic pain sufferers. Poor sleep quality prevents us from concentrating, alters mood (which then further encourages pain) and significantly affects immune system function. There are several useful questionnaires available to download which will indicate where you are on a spectrum of sleep quality. However, a more simple way of looking at it is to just ask yourself, “do you wake up feeling refreshed?” If the answer is “no”, even if you have had a good amount of time apparently asleep, it is likely that poor sleep quality is exacerbating your pain levels as well as your general health. ‘Sleep Hygiene’ or ‘Sleep Behavioural Modification’ refers to some simple and practical routines that you can implement for improving sleep quality and subsequently on pain levels and general well-being.

Some people with poor sleep quality may be suffering from medical conditions with underlying physiological or structural origin such as types of insomnia and sleep apnoea. These patients need to be identified quickly and usually benefit from seeing a Sleep Consultant or a GP with a specialist interest in this area and even taking part in sleep studies, or polysomnography, where their brain-wave activity, muscle tone and other variables such as breathing patterns are analysed whilst they sleep in a laboratory. This can lead to simple medical applications being trialled that often lead to dramatic changes in sleep quality and subsequent general health as well as persistent pain.

It should not be under-estimated just how much positive impact good sleep quality has on pretty much every single part of our physical and mental well-being.

Manual Therapy & Cognitive Functional Therapy (CFT)

Whilst we understand that, ultimately, movement is the key ingredient in restoring normal sensory processing in patients with chronic pain, manual therapy can be a really useful tool to help people feel more able to initially get going again. Manual therapy refers not just to the more passive ‘hands on’ treatment such as massage and manipulation but also to any techniques that can be applied through physical means to assist movement and, importantly, to encourage more optimal or efficient movement strategies. Applied in the right way, they can provide immediate symptom relief or significant symptom reduction and create a ‘window of opportunity’ for many patients to then be able to start moving more freely again without fearing pain and the presumed harmful consequences of pain. Really good quality research, looking at patients with many years of chronic back pain, has demonstrated immediate reduction in pain levels achieved simply by the researchers encouraging more efficient movement patterns. Left alone, patients in pain will often adopt compensatory movement habits that, instead of helping their pain, actually reinforce their problems and are termed ‘maladaptive’. Their bodies are just not quite sure how to get into more comfortable postures and patterns of movement and this is likely to be encouraged by negative thoughts where patients associate on-going pain with more damage or harm. With good pain education and the right encouragement, they can be shown how to move effectively and comfortably again and, importantly, re-conceptualise inaccurate ideas they may have developed about pain that reinforce negative thoughts and behaviours such as fear of the perceived consequences of pain felt during movement and subsequent avoidance of certain movements.

Current research is starting to show just how effective CFT, is in managing patients with persistent pain conditions such as back and neck pain.

Medical Treatment for Persistent Pain

There are a small number of patients who present in clinic with serious underlying medical reasons for their pain. Although this may only account for around 1% of back pain cases, when you consider that 90% of us will have back pain at some point through our lives, this does represent a great many people with potential serious medical pathology as the cause of their symptoms and this must not be overlooked. Thorough screening and, where indicated, scans and blood tests are vital for anyone who’s medical history gives cause for suspicion to avoid missing potentially life threatening illness or conditions that may result in long term disability. The Good Physio has trusted colleagues in Spinal & Orthopaedic Surgery, Neurology and Medical Pain Management who can provide these services.

Despite their best efforts, some patients with persistent pain are just unable to improve their symptoms without more invasive medical interventions. Doctors who specialise in Pain Management are able to advise on the best types of medication to help your specific type of pain as well as administer injections and other interventions such as spinal cord stimulation to help manage this small group of patients with more stubborn pain conditions. Whilst this is often not a permanent solution, it can improve quality of life and also, for many patients, a significant ‘window’ of at least some pain relief where they are then able to concentrate more effectively on the non-medical strategies that will hopefully provide longer terms solutions.

Collaboration

Importantly, all of the clinicians contributing to your care work together, with you at the centre of the decision making process, in order to provide the most effective approach that is right for you as an individual. We deliver an ‘attention to detail’ approach to help you improve your quality of life and enable you to feel like you once more.