June PTJ LEAP_Biopsychosocial LBP

[Michael McMurray]

June Physical Therapy journal _LEAP section article.

Have a read – continue our year long discussion on Biopsychosocial management of patient with chronic low back pain.

What about this piece of the literature helps with specific decision making?

Thoughts???

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[Laura Thornton]

I’m impressed with the successful implementation of multi-disciplinary communication that the GP, psychologist, and PT had. I mean wow, every two weeks a teleconference on patient progress and each member informed on the other’s treatment. Reminds me of in-patient grand rounds in the hospital setting.

Also, to take away from our last course, primary activity limitations:
– Unable to perform previous exercise routine >> immediate introduction of strength training program and gradual return to running program within patient tolerance

– Unable to perform work activities >> ergonomic solutions with workplace visits and simulated work tasks

The patient might not have had huge changes in all the outcome measures, but the main concerns he came in with : days off work, not able to perform previous exercise, difficulty sleeping all had the biggest improvements.

I have said in the past that I struggle with decision making and when to implement greater amount of psychosocial aspects to patient care. You can easily see that the therapists saw the importance of implementing these aspects by assessing through subjective (feelings of anxiety and anger, interference with work, history of condition), outcome measures, and functional tests. They made the decision right away to include the GP and psychologist within the treatment and focused on a supportive, self-efficacious, and purposeful plan. Sure, they added in specific exercises for “trunk strengthening”, but clearly the focus was on a much bigger picture.

[Nick Law]

This piece of literature helps me with decision making by highlighting the MULTIDISCIPLINARY approach to biopsychosocial rehab for low back pain. While I certainly want to grow in my own abilities to perform pain science education and cognitive behavior therapy, the reality is (at least at present) that there are other healthcare individuals who are more specifically trained to administer these services with specific patients than I am. It is outside of my comfort zone and routine and will require more work and effort, however I think that providing the best care for my patients in a biospychosocial framework means that at times I will seek to get them connected to other healthcare providers (e.g., pain psychologist) who will be able to better address certain aspects of the patients care.

[Aaron Hartstein]

The owner of our clinic in Winchester also has a degree in counseling. What is interesting is that she has been doing much of this type of intervention for years, long before it caught fire in the profession. When I was just starting as a new graduate, I used to treat in the room adjacent to her to listen to how she interacted with patients. Through her connections, the clinic also has established a relationship with a local psychologist who specializes in pain. They also have a “pain group” which we have referred patients to in the past. It is great to have this outlet, but you obviously have to be certain you select the appropriate patient for this and they are “ready” mentally for this angle of treatment.

[Kristin Kelley]

I think it’s so valuable that our profession has moved into the realm of treating the “whole” patient so much over the past few years as there is so much more focus on pain science and patient perception of their condition/pain and how much it impacts or maybe even can create a physical manifestation of their symptoms. I think it is important for each of us to consider these factors when treating our patients and altering programs to best meet these needs. I think it is JUST as valuable (if not more valuable) to realize when there is a component of the patient case…or maybe even the entire case…that needs an appropriate referral to a different practitioner for assistance. Eric gave a great example of this at the Rusty Smith course of referring a patient back to her PCP for discussion of some of these types of barriers as she new her level of comfort and the relationship w/her PCP would warrant a better interaction/resolution of non-PT related portions of improving her overall ability to become well. We all have “difficult patient” cases who need more than we can offer. Does anyone see any parallels or examples they can integrate from Rusty’s course and/or a current patient case that they could apply to the information in this article?
KK

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