Chronic Pain Management Series – What Works?

This is part 2 of a series.  Read Part 1 on Persisting Pain. As the advances of modern medical research have progressed, so has the development of manual therapies such as osteopathy. Once seen as a profession purely dealing with rehabilitation or ‘hands-on therapy’, physiotherapy has integrated with essential areas such as behavioural and psychological treatments. By using strategies such as Cognitive Behavioural Therapy (CBT) and Acceptance & Commitment Therapy (ACT), many manual therapists, including osteopaths such as myself, have incorporated a more holistic approach to persisting pain.

Having a holistic approach is essential for treating a multifactorial problem. Would you only perform bicep curls to lose weight? No. Would you only learn to serve if you wanted to play tennis? No. So why should longstanding pain, such as sciatica or chronic shoulder pain be managed with only physical treatments? It shouldn’t. By seeking the assistance of someone specialised in CBT or ACT, you are expanding the avenues for managing your pain and improving your chances of a life with reduced pain and improved quality of life.

When Hands On Is Not Enough

Well, how should we manage chronic pain then? Maybe you can try a fortnightly massage that provides only very mild short-term relief. Or maybe you are tolerating the numerous side-effects from your prescription medication. These are the old-school methods that only mask your symptoms temporarily and do not address the root cause of your pain. 

“[Chronic pain] disorders involve a specific psychological vulnerability that could be described as a tendency to respond with fear to perceived physical sensations, which in turn leads to avoidance behaviours.”

-Dr. Ruiz-Parraga & Dr. Luis-Martinez (2014)

By looking at many people suffering from chronic low back pain, Ruiz-Parraga and Luis-Martinez highlight the maladaptive behaviours that are commonly seen in people with this kind of persisting pain. “Maladaptive behaviour” can be defined as inappropriate coping mechanisms in response to certain stimuli or sensations. This statement reiterates the sentiment of how multi-layered and complex chronic pain can be.

Although traditional treatment has proven to be very effective for treating acute pain and dysfunction; more modern approaches are needed to work with what we know about the neurophysiology of chronic pain. Techniques such as hands-on therapy and exercise can be extremely beneficial, but they don’t alone often account for any psychological factors and maladaptive behaviours. In fact, an over-reliance on hands-on therapy such as massage can create a dependence on costly passive treatment which ultimately never ‘fixes’ your problem.

Does that mean osteopathy is not a suitable option for longstanding pain? No. Osteopathy has helped many people with longstanding pain. However, with advances in rehabilitation knowledge makes more active and engaged approaches more comprehensive and effective. And then there are specialised therapists like myself who use approaches such as ACT and CBT in helping people with complex or longstanding pain.

Part 3 will explore the approaches mentioned here and how they work.