Physiotherapy in hospitals, clinics and the community aims to achieve healthy levels of activity and self- management for people with chronic pain. Clinical and cost-effectiveness evidence supports using a cognitive behavioural approach addressing both physical limitations and people’s beliefs about, and understanding of, their condition. People with multiple health issues or whose pain is causing significant physical, psychological or social problems may require management by a multidisciplinary pain service. Specialist physiotherapists identify reasons for lack of progress in rehabilitation, such as fear avoidance of movement or unhelpful patterns of over-and under-activity.
GP referral to services for advice and exercise improves outcomes and is cost-effective. Using a risk-stratification tool and providing risk-matched treatment improves the condition, shortens time off work, reduces sickness certification and healthcare costs.
Manual therapy or acupuncture may produce short term benefit, but evidence supports the use of active treatments such as therapeutic exercise. Multidisciplinary pain management programmes (PMP) including physiotherapy are an effective intervention for people with chronic pain and cost-saving compared to physiotherapy alone.
The role of the occupational therapists is to find out how a persons’ persistent pain affects day to day tasks that they need and want to do, and help them find ways of improving their ability. These things can include getting washed and dressed, playing with their children or grandchildren, housework, shopping, performance in work, hobbies or going out with friends.
We acknowledge that we cannot provide pain relief, but we can help people to improve their quality of life and activity level – even in the presence of pain. We do this by training people in the use of mindfulness, facilitate target setting and activity management, and provide educational talks and interactive workshops on subjects such as “Change”, “Balanced Lifestyles”, “Value Driven Targets” and “Communication”.
For people who are working, occupational therapists can write to employers to provide information and recommendations on using pain management techniques in the workplace. They can also give advice to people who would like to return to work and refer on to external agencies as appropriate.