Understanding and Treating Chronic Pain as a Physical Therapist

 

Background:

During the Spring of 2022, I was on my second clinical rotation at an outpatient UNC healthcare center where I saw all kinds of patients involved in land and aquatic therapy. The patients that really stuck with me were the ones with various kinds of chronic pain. I remember the first patient with chronic pain I saw had been experiencing significant chronic hip and lower back pain for years that limited quality of life and functional ability to a degree I had never thought chronic pain could. I learned so much about how pain can affect someone during my involvement in treating that patient both on land and in the pool and the experience was extremely moving. There were multiple sessions involving both tears of joy due to progress and tears of frustration due to the recurrence of pain.

One of the biggest takeaways from that experience was that the patient-therapist bond matters to such a great extent when the patient is experiencing chronic pain. During the evaluation, it was almost impossible to get the patient to do anything except talk about the pain and try small movements with no success. However, as the sessions went on, the conversations got deeper and more trust was formed. The sessions got more and more productive and the whole mood changed. I could feel the motivation to get better had been instilled in the patient and the results were astounding.

When considering what to research for my capstone, one of the first thoughts that came to mind was about this patient and how the psychological change in the patient had changed the whole treatment process for the better. Time and time again I have witnessed patients and people outside of therapy make huge physical leaps during periods of improved mental health. I began looking into the psychology behind chronic pain and I was hooked.

 

Statement of Need:

Patients with chronic pain are often misunderstood. Health professionals such as physicians and physical therapists often treat chronic pain as a symptom of an underlying pathology when chronic pain can be the pathology itself. When chronic pain is treated as a symptom, the person as a whole is not taken into account. Chronic pain is oftentimes just as much a mental health condition as a physical ailment. It is imperative that healthcare providers learn more about how to properly assess and treat patients with chronic pain by way of the biopsychosocial model in order to be able to provide the best course of action for these patients. Physical therapists and other medical professionals often feel as though they are unequipped to deal with the psychological aspects of chronic pain that patients come in having trouble with. More information about how to assess and treat chronic pain effectively in a holistic manner needs to be put out there for providers in order to improve the quality of care provided to patients with chronic pain.

 

Purpose:

The primary purpose of my capstone is to spread information about chronic pain to other healthcare providers and future healthcare providers in order to improve the quality of care patients with chronic pain receive in the future. My capstone provides background information on the neuroscience and psychology behind chronic pain as well as information on how to best assess and treat chronic pain by way of the biopsychosocial model. The target audience includes clinicians and healthcare students. A presentation is included for an in-depth learning experience on chronic pain and a brochure is included as a faster method of delivering information for use in clinics.

 

Products:

For physical therapists and physical therapy students, I created a lecture with audio that provides information on chronic pain neuroscience, psychology, evaluation methods, treatment methods, and medication. The information in the lecture is evidence-based with all of the references listed at the end.

Lecture With Audio

 

I interviewed two patients who have been experiencing chronic pain for years and their experiences are shared and compared here with audio.

Patient Experiences With Audio

 

I have here the lecture and patient interview slides without audio as well.

Lecture Slides Without Audio

 

I also came up with a faster learning experience about chronic pain in the form of a brochure that can be distributed to clinicians and students in clinics or in the classroom for a quicker form of learning and something to refer to. The information in the brochure is evidence-based with all of the references listed at the end.

Chronic Pain Brochure

 

Here is a list of possible additional subjective questions I created that physical therapists may want to consider adding to their subjective during the evaluation of patients with chronic pain. I formulated the questions based on the patient interviews and chronic pain evaluation research.

Chronic Pain Subjective Question Options

 

Here is the evaluation component that I used to get feedback on the brochure. This form was sent out with the brochure to various clinicians and students.

Chronic Pain Brochure Feedback Form

The responses suggested that the brochure was well put together with a lot of useful information. Many of the responders suggested they would hand the brochure out in classes and clinics and that it made them feel at least somewhat more comfortable treating patients with chronic pain. One important thing I was able to take from the feedback was that the brochure could be better organized in some ways in order to be more readable when printed out.

 

Self-Assessment:

At the beginning of the assignment, I expected to learn a decent amount about chronic pain neuroscience, psychology, evaluation, and treatment and learn how to share that information effectively with other clinicians. After completing the assignment I can reflect back and realize that I learned way more than I imagined. I also ended up having two incredible, very deep conversations with patients that I think will serve me extremely well as a provider in the future. My goals were to become more educated on pain neuroscience and to learn how to evaluate and treat chronic pain as a physical therapist so I could show others. I ended up accomplishing a lot more than that by delving deep into the literature on chronic pain and especially by interviewing those patients. I learned what really matters to two very different patients with chronic pain and I think out of all of the experiences from this assignment, those interviews were the most helpful. I want to continue to grow in the area of being able to strengthen the patient-therapist bond with my patients and I think this project ignited that motivation at such an essential time for me toward the end of my schooling.

 

Acknowledgments:

To Jessica Cassidy, thank you for being my primary advisor for this eye-opening project. I always appreciated your concise yet extremely effective feedback and your efficiency in getting it to me. Every time I left one of our bi-weekly meetings I felt a renewed sense of excitement and confidence regarding this project and it really became a passion of mine over time in large part because of you.

 

To Rebecca Zhang, thank you for being part of my committee and helping with the initial inspiration for this project. I don’t know if I ever would have thought of this topic in the first place without you. Also, thank you for giving me such helpful, prompt feedback throughout the process.

 

To Erin Morstad, thank you for being part of my committee and helping so much with my overall journey as a developing physical therapist. I definitely would not be as confident and comfortable trying to develop patient-therapist bonds if I had not worked under you. Also, thank you for your quick and effective feedback as well on everything I sent your way.

 

References:

References used are included at the end of the lecture and on the last page of the brochure.