Evidence on interdisciplinary teams According to a systematic review of randomized control trials for multidisciplinary rehabilitation interventions for low back pain, a coordinated intervention, using a biopsychosocial rehabilitation approach provided by clinicians from different practice areas is most likely to result in reduced pain in the long term (Kamper et al., 2015). Clients who received treatment at the discretion of their healthcare provider or physical treatments including heat, electrotherapeutic modalities, stretching, strengthening, manual therapies or education were less likely to have long lasting effects. Because of the variations in the skill or experience of the clinicians and the design and intensity of the program components, it is difficult to identify the specific mechanisms Maximizing the effectiveness of interdisciplinary teams Working as part of an interdisciplinary team has its challenges. Efforts to develop a coordinated team should include continuous interaction, coordinated efforts, and knowledge sharing among all members (Inman, Briggs, Theriot, & Heaston, 2016). Active listening, encouragement, confidence, empathy, approachability and nonverbal communication skills are needed for the effective rehabilitation of clients who participate in rehabilitative programs (O’Keeffe et al., 2016). Biopsychosocial approach within the interdisciplinary team Tzenalis, Beneka, Malliou, Godolias, and Staurou (2016) identify the biopsychosocial model to include four components: patient education, CBT, relaxation training, and active adaptation. Each of these components is interrelated. Patient education focuses on self-efficacy; CBT helps a client change their thinking and behavior; relaxation training is used to reduce neuromuscular effects; active adaptation addresses the environment or lifestyle. This systematic review of biopsychosocial rehabilitation for chronic neck and low back pain identified randomized controlled trials in which one or more of the biopsychosocial treatments Relaxation techniques In a review of the literature, Yukari, Noriko, Yoshiki, and Mizue (2015) found that relaxation techniques either decrease pain intensity or provide pain relief. Other potential benefits include the following: ● Reduced anxiety. ● Fewer stress-related symptoms. ● Reduced percentage of disability. ● Improved mood. ● Increased the secretion of endorphins. ● Increased self esteem. (Metikaridis, Hadjipavlou, Artemiadis, Chrousos, & Darviri, 2017; Onieva-Zafra, García, & del Valle, 2015) Some of the more common types of relaxation strategies include: ● Guided imagery: Is founded in the knowledge that the body and mind are connected (Elliott Patricolo, LaVoie, & Slavin, 2017). Though not well understood, it is believed that guided imagery may involve changing how the mind perceives pain Biofeedback Biofeedback is a treatment modality used to control breathing and heart rate. Clients can improve understanding of the mind/ body connection by making pain visible (Krishnan et al., 2018). An individual learns to control their body and relax muscles. With this control, the fear of pain decreases, which in turn reduces the stress caused by pain and finally, reduces the perception of the pain. (Krishnan et al., 2018). The three most commonly used biofeedback approaches are as follows: 1. Electromyography (EMG) : Which measures muscle tension. 2. Thermal biofeedback : Which measures skin temperature.
that are most beneficial. Positive outcomes from the implementation of interdisciplinary teams providing several components of a biopsychosocial model include reduced pain and disability that continues for greater than 1 year and improved likelihood of return to work when compared to physical treatments (Kamper et al., 2015). At this time, there is no exact measure for duration of treatment. A systematic review completed by Waterschoot et al. (2014) was unable to determine an optimal estimate for intervention intensity. Interdisciplinary treatment is often expensive, time consuming, and resource intensive, posing a potential hardship on the client and the healthcare system, however, it provides the most effective treatment at this time. Discussions around pain management between the client and practitioners can be difficult, and this will impact the care provided (Haverfield, Giannitrapani, Timko, & Lorenz, 2018). Collaborative treatment in which the clinician and client agree on goals, roles, and treatments is recommended to improve adherence to goals and enhance overall self-management (Wijma et al., 2017). Recommended communication strategies include openness, listening, trust, and solution-oriented, as well as customization of intervention plans (Haverfield et al., 2018). were used. The authors found the educational approach to be beneficial in addressing client “worries, attitudes toward self care, pain intensity, fear-avoidance and functional outcomes” (Tzenalis et al., 2016, p. 44). CBT was found to produce better results over the long term when looking at reducing disability and healthcare visits. This intervention focus also reduces pain intensity and improves functional status. There was strong evidence for adding CBT and active adaptation approaches to a biomedical approach for a more comprehensive and effective outcome.
MIND/BODY TECHNIQUES TO CONTROL PAIN
(Elliott Patricolo et al., 2017). The client imagines a pleasant experience or a soothing environment; the mind becomes absorbed in this task rather than focusing on potentially painful and anxiety-producing stimuli. ● Deep breathing : Also known as abdominal breathing . A review of the literature suggest that pain influences respiration and paced, slow breathing is associated with reduced pain. The mechanisms underlying this effect however, are not well understood (Jafari, Courtois, Van den Bergh, Vlaeyen, & Van Diest, 2017). ● Progressive relaxation : Involves tensing and releasing successive muscle groups while focusing on the differences in sensation that occur (Charalambous et al., 2016). Once learned, this technique can be used to relax muscles at the first signs of tension. Progressive muscle relaxation has been found effective in controlling pain (Charalambous et al., 2016). 3. Neurofeedback or electroencephalography (EEG) : Which measures brain wave activity. While there is no conclusive evidence to support the effectiveness of biofeedback, there are data that support the analgesic potential of this intervention (Castelnuovo et al., 2016). Simple and affordable biofeedback devices can be purchased for home use or as a smartphone application. These devices typically measure temperature, heart rate, and breathing rate. A practitioner does not need to be certified in their use to incorporate these devices into an interventional or educational session.
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