Over the past couple of days I’ve had the need to really think hard about my practice in pain management. Some of you will know that I hail from New Zealand, and my origins are as an occupational therapist, with subsequent study in psychology, and wide-ranging readings and training and supervision and experience in a whole bunch of other areas (including case management, health and safety, policy development and so on).
Some things are really quite essential in chronic pain management especially – adopting a cognitive behavioural approach, using an interdisciplinary team, having a biopsychosocial model of pain… nothing really controversial there (unless you LOVE hands-on therapy, or think all pain can be abolished through injections/surgery/medications!).
What I’m facing right now is a really significant challenge to what I’m able to do (and be funded for) in both assessment and intervention. A new contract has been drawn up by a major health purchaser that restricts ‘psychosocial’ assessment (usually included with biomedical and functional as parts of a comprehensive assessment of the person with chronic pain) to ‘psychological’ assessments that must be carried out by psychologists. At the same time, the content of this assessment has shifted the areas to be assessed to eliminate the ‘social’ or contextual aspects of the pain presentation.
In the interventions area, the programmes that may be provided to people with pain MUST include sessions with a psychologist, and areas of coping that are often provided by occupational therapists (such as thinking about thinking, relaxation training, graded exposure and so on) are to be provided by psychologists.
Now I’m the last person to want to get involved with a turf war – I’ve always said that it’s important to ask yourself ‘what can I contribute to this team?’ rather than ‘what is my role?’ – but this really does cast doubts on my profession, and my ability to carry out what I think are fundamental skills of all therapists working in the field of pain management. I can’t see what the benefit to people experiencing pain will be to make these sorts of changes.
For me, the question is: can I ethically provide interventions to an individual withoutusing therapies that I am both competent in, are part of my professional repertoire and from the literature, have been shown to work? I don’t think so – what do you think?