Background & Aims

Pain persistence after healing process could annulate its protective function and lead to patients suffering and detriment of participation and quality of life. The chronification of pain experience constitutes a major global challenge and a source of significant suffering, disability and healthcare costs1: its complexity, with psychological, social, and biophysical contributors was addressed in the following case-series.

Methods

Semi-structured interviews were conducted in n 12 patients with different persistent pain conditions chronic non-specific low back pain, complex regional pain syndrome, fibromyalgia, failed back surgery, recurrent knee pain in elderly patients. Under a dispositionalist patient-centred approach2, the therapeutic process was multidimensional in nature, encompassing biomedical, psychological, social aspects, and enabling the construction of an intersubjective3 space between the clinician and the patient, where the characteristics of both can find a space headed towards a narrative shared sense-making process and an appropriate engagement4-5. They were evaluated under a multidimensional framework with initial and post-intervention administration of self-reported outcome measures to assess functional and psychosocial aspects and, as measures to evaluate patient’s mindset change and self-management strategies, were used Coping Strategies Questionnaire and Pain Self-Efficacy Questionnaire.

Results

Emerging themes from patients’ interviews at initial assessments and at post-intervention time were deducted and grouped as follows, respectively:
•Baseline:
-feeling isolated and frustrated
-feeling unbelieved and unvalidated
-uncertainty navigation in pain management
•Post-Intervention:
-construction of personal pain experience meanings
-self-management strategies acquisition
-feeling empowered with much more health literacy
At the end of therapeutic journey, patients’ mindset changes and personal engagement in self-management strategies improved at final re-evaluation comparing to baseline, with the sensible reduction of other patients self-reported outcome measures administered.

Conclusions

Therapeutic pathways in persistent pain states should be shaped towards a multidimensional framework whose the main objective is to reach a meaning(s) of pain experience, where the uniqueness of single clinical presentation can be effectively met and managed condescendingly.
In complex persistent pain states, psychologically informed practice6-8 should guide the therapeutical journey, with a merging of Motivational Interviewing (MI)9 framework in lower irritability clinical presentations, and Acceptance and Commitment Therapy (ACT)10-11 in much complex scenarios, in order to improve psychological flexibility and enhance personal self-management activation.

References

1.Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197–223.
2.Anjum RL, Copeland S, Rocca, E. Rethinking causality, complexity and evidence for the unique patient: A CauseHealth resource for healthcare professionals and the clinical encounter. Springer 2020.
3.Low M. A novel clinical framework: the use of dispositions in clinical practice. A person centred approach. J Eval Clin Pract. 2017;23:1062-70.
4.Launer, J. Narrative based practice in health and social care: conversations inviting change. 2018. Routledge, London.
5.Low M. Managing complexity in musculoskeletal conditions: reflections from a physiotherapist. In Touch. 2018;164:22-8.13.
6.Nicholas MK, George SZ. Psychologically Informed Interventions for Low Back Pain: An Update for Physical Therapists, Phys Ther. 2011;91(5):765-76.
7.. Main CJ, George SZ. Psychologically informed practice for management of low back pain: future directions in practice and research. Phys Ther. 2011;91(5):8207.
8.Ball1engee LA, Zullig LL, George SZ. Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go? J Pain Res. 2021;7(14):3747-757.
9.Nijs J, Wijma AJ, Willaert W, Huysmans E, Mintken P, Smeets R, Goossens M, van Wilgen CP, Van Bogaert W, Louw A, Cleland J, Donaldson M. Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians. Phys Ther. 2020 May 18;100(5):846-859
10.Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KM. Acceptance and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther. 2016;45(1):5-31.
11.Tatta J, Willgens AM, Palombaro KM. Mindfulness and Acceptance–Based Interventions in Physical Therapist Practice: The Time Is Now, Phys Ther. 2022;102(3):pzab293.

Presenting Author

Andrea Celso

Poster Authors

Andrea Celso

MSc

ASFO PORDENONE FRIULI VENEZIA GIULIA ITALY

Lead Author

E-mail

Topics

  • Models: Musculoskeletal

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