The development of a chronic pain self-management course within the British School of Osteopathy Clinic

• Published in: International journal of osteopathic medicine 2013-03, Vol.16 (1), p.e11-e12
• Main Authors: Abbey, Hilary, Nanke, Lorraine
• Format: Article
• Language: English
• ISSN: 1746-0689
• DOI: 10.1016/j.ijosm.2013.01.007

Still's maxim ‘Find it, fix it and leave it alone’1 is relevant for acute nociceptive pain but chronic pain causes are difficult to find, and ongoing care a more likely outcome. Neurophysiological and psychosocial research demonstrates that cognitive factors can influence the progression from acute to chronic pain.2,3 Pain management research shows that Acceptance and Commitment Therapy (ACT), with Mindfulness, can be as effective as Cognitive Behavioural Therapy (CBT).4,5 Osteopaths may feel less effective when treating patients who cannot be ‘fixed’, especially with limited access to effective pain management programmes. Evaluation changes are being implemented at the British School of Osteopathy (BSO) to emphasise the concepts and clinical reasoning on which osteopathic evaluations and management decisions are based. New psychosocial assessments are also proposed to identify patients at risk of chronicity and devise pathways for providing appropriate, collaborative care. To develop a pain self-management course to improve quality of care and help osteopathic students develop effective ways of enhancing function and agency in chronic pain patients. Mixed methods, repeated measures, observational study, using qualitative data from assessment interviews and follow-ups after 2 weeks and 3 months, and quantitative data from questionnaires at baseline, course end, and 3 months; Chronic Pain Acceptance Questionnaire6; Chronic Pain Values Inventory7; Bournemouth Pain Questionnaire8; WHO Quality of Life Questionnaire; Bulls Eye; and Patient Enablement Index. A purposive sample of patients with non-pathological pain (>6 months) attended a 6-week psycho-educational ACT based course. 9 patients participated in Nov–Dec 2010 and 8 in Feb–March 2011. Questionnaires were analysed for changes in health beliefs, values, and pain-related behaviour. Interviews were analysed to explore individual pain narratives. Seven participants completing the first group reported that course material and peer group support helped to increase their understanding of persistent pain and the effects of sustained stress. They explored personal losses in physical health, occupational roles and social relationships and identified habitual, avoidant, psychological responses to pain. Preliminary analysis showed participants benefited from sharing experiences and mutual support but found it difficult to commit to more fulfilling, valued living activities. Trends showed improvements in pain but le