These people may consider the pain to be “all in the head” or the result of “hysteria” or a low pain tolerance. Pain diagnoses associated with stigma include low back pain, fibromyalgia, and migraines. Stigma about pain can lead to undertreatment (Collier, 2018; McInnis, McQuaid, Bombay, Matheson, & Anisman, 2015). A systematic review of the literature by Cooper and Nielsen (2017) found that people who use prescription opioids experienced stigma related to their substance use. This study also found that those who were using prescription opioids conveyed a stigma against those who used illicit opioids.
It is important not to limit recognition of stigma only to that placed by family, friends, and coworkers. Practitioners need to recognize that their own biases, both conscious and unconscious, may affect treatment (Cooper & Nielsen, 2017). These biases could be related to the client’s personal life choices, culture, appearance, or temperament. Overall, the experience of pain is individual; it is important for healthcare professionals to listen to the client’s experiences and validate the client’s pain in order to establish a strong rapport for therapy.
INTERDISCIPLINARY TEAM APPROACH
There is often confusion between the terms multidisciplinary and interdisciplinary . A multidisciplinary approach can be described as more than one healthcare provider (not necessarily at the same location) treating a client’s pain condition, without necessarily coordinating care or communicating with one another. An interdisciplinary approach involves coordinated interventions among disciplines at the same location in an integrated manner with common goals and ongoing communication (Gatchel, McGeary, McGeary, & Lippe, 2014). In research and practice, these terms are often used interchangeably, and for the sake of this course, we will use the term interdisciplinary because of the 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.
need to move from discipline specific practice to a collaborative focus on common goals (Patel, Hacker, Murks, & Ryan, 2016). Interdisciplinary teams have included physicians, physiatrists, psychologists, physical therapy practitioners, kinesiologists, nurses, pharmacists, dietitians, health and advice workers, fitness workers, cognitive behavioral therapists, chiropractors, rheumatologists, and social workers (Hammer et al., 2016; Hellman, Jensen, Bergström, & Brämberg, 2016; McGeary et al., 2016). 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
● 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)
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Book Code: SWUS1524B
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