If you’re new to pain management

This is just a brief foray into thinking about what people new to pain management might need to know in the first few months.  I’m definitely not being academic about this, and I don’t have any references – it’s my reflections on seeing people starting in the field looking a bit like a possum in the headlights!  (For non-kiwi’s, the possum is high on cuteness, and more than high on destructiveness – and one of the best ways to catch a possum is to go spotlighting!)  (Photograph by PJWood, apologies for not crediting this before, this image is common on the internet).

There are no easy ways to learn about chronic pain management – as a field it’s huge and I think the complexity of it needs to be acknowledged.  I don’t, for example, think it’s the best field for a new graduate occupational therapist, physiotherapist, nurse or psychologist to work in.  And I sincerely believe that even if you’re an experienced health professional you need loads of collegial support over the first few months especially as you enter the field.  Oh, and lots of time to read and absorb the literature around the field too.

I’m not going to detail resources today – that’s a job for tomorrow – but I do think there are some basic domains of knowledge that are good first targets for learning.

The first is the biopsychosocial model. Without understanding this model, pain management simply doesn’t make sense.  Well actually, pain itself doesn’t make sense without this model.  It’s important to understand the concept of pain being an ‘unpleasant sensory and emotional experience’, while the bits we can actually detect are only the behaviours surrounding the person’s internal experience.  The ‘Onion ring’ model is a great way to learn the interactions between various elements in the experience.

I think it’s important to review some of the basic models of pain – like the gate control theory and the neuromatrix, and be conversant with some of the basic neurolobiology of pain.

As a ‘newbie’ to pain, it would be important to really come to grips with the cognitive behavioural approach for pain, and that pain behaviour is one of the primary targets rather than purely focusing on reducing pain intensity.

This means coming to grips with the key cognitive aspects of pain – things like patient beliefs and judgements, the disruptive effect of pain on thinking clearly and attention/concentration, the effects of misheard statements by other health professionals and well-meaning family and friends.

And of course, the effect of pain as a stressor, the emotional and motivational effects of pain.  Knowing about anxiety, depression and sleep would be helpful.

Knowing the difference in approach used for acute vs chronic pain – and the factors that influence chronic disability from pain right from the beginning of the acute pain experience – is imperative.  This means changing the focus from talking about pain to talking about function and action and doing!

It might be helpful to know a bit about medications and how/why they are used, the side effects, the way they affect pain, and common concerns that people who live with chronic pain have about taking medications.

A bit of anatomy would be great – it’s amazing how little people know about how their bodies actually work!

And of course, knowledge about how people learn and how behaviour is influenced, as well as the social settings in which people have their pain.

And I haven’t even started on treatment approaches yet, just describing pain as a phenomenon!

You can see why I don’t think this is an area that therapists and health professionals should simply ‘dabble’ in.  It’s vast, draws on multiple fields of knowledge, and requires great generic therapeutic skills as well as the technical knowledge needed to help people develop new ways of living despite their pain.

My hats go off to my colleagues in pain management – what an incredible group of people! We work with people who have one of the most difficult health problems in the world, one that affects every aspect of life, and we do it with passion, pride – and in the middle of an ever-increasing range of information (and misinformation).

If you’re new to pain management – welcome aboard.  Don’t be shy, get connected and then hold onto your hat, because this is a wild and bumpy ride full of complexity and emotion, but oh so rewarding.


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