Helen Ambler, Highly Specialised Physiotherapist in the Chronic Pain Self Management Team, St Georges Hospital, London and Jake Webster, physiotherapy student in London South Bank University reflect on their attendance at Ben Cormack's lecture for the Physiotherapy Pain Association in UCLH on 27th June.
A Specialist's Insights
Despite Helen's experience in pain management, she found Ben Cormack's approach helpful to clarify the key points to consider when supporting people to get more active or commence exercise.
There were many interesting points raised during this lecture and I’ve summarised some of these points below. Full disclosure – this is my interpretation only! In practice, when we see a person that is experiencing pain and thinking about exercise and activity with them, there are some key things that we need to understand from them.
What meaning do they give their pain – what are their beliefs and understanding?
- This can have a significant impact on the person’s motivation and perceived ability to engage in physical activity.
- If we can understand what someone believes their pain to mean, there is the possibility that we can influence this.
What are their motivations, expectations or predictions when they are considering exercise? Do they think they can do what you are asking of them? How does pain affect their motivation?
- What barriers a person in pain has to engaging in exercise or activity. Have they stopped some or all activity due to worries or fear that they will increase their pain or that their pain will get worse? Are they worried that they will cause damage if they do the exercise you are asking them to do?
- Pain self-efficacy is a person’s perceived ability to perform tasks whilst in pain. We need to know whether they can manage to do some things whilst in pain. Are we able to reassure them that ‘it’s sore but safe’ to do the exercises or activities we are asking them to do?
- Are there other barriers to exercise and activity for the person you are seeing, such as time pressures, work commitments, confidence, mobility, financial? Exploring these barriers and collaboratively making a plan that works best for the person, thinking about how and when to do it, can be really helpful.
How do we assist behaviour change and improve activity levels?
- Know what is influencing the person’s pain and also, how pain is influencing the person.
- Understand the meaning of the pain and exercise to the person.
- What is relevant and important for the person to be working towards.
- Our treatments must be individualised to the person in front of us. Listen to what they are telling us and work with this.
- Most importantly, work in collaboration with the person we are seeing.
In this lecture, Ben advocated well what a lot of us are already doing in the field of chronic pain self-management. We understand the importance of really listening to our patients and trying to understand their beliefs about pain and exercise and the impact pain and reduced activity levels can have on their lives. We work towards understanding what our patient’s values are, and take a graded, goal setting approach to help them work towards what is important to them and hopefully improving their activity and exercise levels alongside this.
These messages are important not only in the field of chronic pain management but in all areas of healthcare where we interact with people experiencing pain.
A Student's Perspective
Jake had just completed his second year of his BSc in Physiotherapy, but his keen interest in pain science and it's management bought him to UCLH on a lovely summer evenening.
Ben provided a well-structured and thought out lecture that had the audience hooked from the beginning ‘What does the biopsychosocial (BPS) model/framework mean to you?’. A question that would appear to be simple to answer in a room full of healthcare professionals, but as a collective, we had difficulty defining what the BPS model meant to us. Ben then shared where he believes we, as healthcare professionals, focus our attention. As a student, I was invigorated to hear Ben talk openly about his own reflections including the mistakes that he has made, and that he has a lot more to learn. Ben provided a context to why he believes the BPS model should be seen as intertwining layers rather than separate entities, and why healthcare professionals' focus needs to shift away from just the biological aspect of the model
Throughout the lecture, Ben used a range of literature to support his discussion and also signposted to other relevant reading. I found the analysis of the literature surrounding self-efficacy, motivation and goal setting extremely helpful and Ben’s passion for these areas shone through, which has made me curious to delve deeper. I found it refreshing how the lecture was patient focused throughout and I thought Ben did a great job emphasising this point. Ben also provided a lot of useful resources and examples that could be easily used with patients.
I found the event a great opportunity to network with like-minded people who are interested in the field of pain. Overall, I thought this was great value. Ben provided an honest approach to delivering the content and made no claims that he could answer all the questions surrounding exercise, activity and pain.
Ben delivered a lecture that provided some of the answers around using activity and exercise within a BPS framework in a way that sparked my curiosity and he facilitated discussion around a complex area that warrants further research.
The PPA would like to thank Ben Cormack for delivering a great evening of clinical gems.
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