Challenging, complex, difficult, draining, dread … these were just some of the words used when I asked a group of musculoskeletal (MSK) physiotherapists what came to mind when they saw ‘chronic pain’ on a referral. Persistent pain is a common issue, affecting at least 20% of the Scottish population and many people with persistent pain will seek advice from a physiotherapist. However, it is a complex issue, and one that many physiotherapists find to be a tricky challenge, as reflected in the word cloud of responses below. As an Advanced Practitioner working within a specialist Pain Service, this is a challenge I face every day, and one that I find intriguing and rewarding to manage. I applied for a NES AHP Fellowship to help me develop training and resources to help turn the challenge from one dreaded by some of my physiotherapy colleagues, to a challenge they felt confident and supported to work through.
Celebrating our successes
So what can physiotherapy do for a person with persistent pain? This was another question I posed to my colleagues and I was really encouraged by the responses which are summarised in the word cloud below. With an emphasis on education, listening, encouragement, and improving quality of life, it is clear that there is good awareness of how we can empower people to live a better life with their persistent pain. With all these fabulous tools in our toolbox, what is getting in the way and making pain management such a challenge? Before I tackle the task of supporting my colleagues with this, I thought it was important for me to understand the barriers they are facing.
What gets in the way?
It wasn’t a surprise to me that the issue of time was at the forefront of the perceived barriers. This is an issue that has come up repeatedly during my previous teaching sessions with colleagues. I work within a specialist pain service and am therefore able to allocate more time to work through the complex issues that can arise when supporting people with chronic pain. I know that physiotherapists working within MSK services and GP practices are much more time limited and increasing appointment times isn’t always an option. I am keen to understand how clinicians can make the best use of short consultation times when dealing with the complexity of chronic pain. However, it appears that this is not the only issue. It is clear that many clinicians have reduced confidence in their own knowledge of pain management, the resources and support that is available, and how to manage the patients’ expectations. Through conversations with some of my colleagues I have learned that, while learning resources are helpful, it is learning in practice that is often most useful. It is apparent that a variety of learning resources is required, from reading materials, to interactive case studies and shadowing opportunities. It is important that clinicians feel confident about having open conversations about expectations of treatment, and are able to fully support people in their self management by encouraging them to act on the advice given in the resources they are signposting to. My hope is that by improving confidence in pain management, that physiotherapists will become more empowered to empower their patients, and maybe even begin to enjoy the challenge!
Breaking down the barriers
So what next? This exercise has helped give me a better understanding of the barriers my colleagues are facing. I am so grateful that I have been given time and support through the NES AHP Fellowship to develop the resources to break down some of these barriers. As with making progress with pain management, helping my colleagues to improve their knowledge and confidence in managing pain more effectively will take time. I hope that by providing my colleagues with further training, resources and support, the dread will begin to lessen and they will face the challenge with confidence and enthusiasm. I’d love to hear more about your thoughts on chronic pain management – what are your own challenges, what has worked well and what support would help to improve your confidence in this area?
AHP Career Fellow