A Holistic Approach to Managing Both Physical and Psychological Pain

Holistic approach to pain management

By using a holistic approach we can treat chronic pain as a complex, multifaceted experience that is unique to each individual.

Our instructors believe a holistic approach to wellness will lead to better overall health outcomes for everyone. 

Everyday, our Core Fitness instructors and therapists uphold their duty and responsibility of aiding clients who are experiencing varying amounts of pain. 

As such, when it comes to the highly sensitive topic of pain management, it is important for all parties involved to understand pain as a complex, multifaceted experience that is unique to each individual due to the sensory and affective components it encompasses. In other words, pain should not be understood from a purely physical perspective i.e. the severity of the injury, and understanding it should include the psychological and emotional aspects of pain. By using a more holistic approach, we can look at it as a whole and understand how it affects people in other parts of their life.

The affective component of pain includes emotional, cognitive, and behavioural attributes, which creates the sense of suffering that accompanies a traumatic event. Most times, the more distressed a client is about chronic pain, the more likely the pain is considered by doctors to be an emotional rather than a physical problem. Indeed, pain has a greater effect on the individual than is typically observed at the surface and until each aspect of the patient’s pain is considered, from anatomic-physiologic to psychological, treatment cannot be considered to truly have a patient-centred approach .

It is pertinent to note that the psychological component surrounding pain is often more limiting than the physical pain itself and this overlooked component can upend even the best treatment strategies and interventions as patients, particularly those with chronic pain, undergo changes within their social networks, resulting in interpersonal difficulties, isolation, anxiety, and depression. With this in mind, it is essential for physical therapists to incorporate psychological strategies and empathy into treatment sessions.

Yellow Flags

When considering “yellow flags” and negative predictors of recovery, therapists must consider where the patient is in their cycle of pain as said cycle can quickly become debilitating, with causal factors such as reduced activity, negative thoughts and beliefs, and prior treatment failures.

For some acute patients, psychological interventions to dispel fear avoidance beliefs can prove invaluable in preventing acute pain from turning into chronicity. While having an actual diagnosis may help to reassure some patients, such a medical diagnosis can prove to be increasingly detrimental to other patients who may develop a significant fear of movement and further injury, so much so that they selectively limit their performance at home, work, recreation and in society in order to avoid discomfort. For these patients, simply stating that “exercise will not hurt you” is akin to saying that touching a hot stove will not result in injury.

So here are a couple types of intervention useful in such cases:

Graded Exercise and Graded Exposure

Graded exercise and graded exposure both involve the patient identifying activities they are fearful of performing due to their pain, after which the physiotherapist then works directly with the patient to set realistic goals and expectations for treatment. This is an important step, especially when treatment is focused more toward pain management and maximising function.

In graded exercise, pain is not used to determine prescribed exercises or activity level in an effort to direct the patient away from their focus on pain. For patients with higher levels of fear however, graded exposure may instead be necessary to serve as the behavioural treatment of choice.

With graded exposure, exercise is not progressed until fear subsides at each stage. It is usually reserved only for patients who have very clear signs of fear toward movement and fear of reinjury as such a conservative approach is not as beneficial for patients only demonstrating decreased activity.

Cognitive Restructuring through Mindfulness

Mindfulness is another wonderful tool therapists can employ to get patients to feel a greater sense of control over their pain and enable them to return to a more normal life, despite the presence of pain. When employed correctly, mindfulness can help attenuate the overall experience of pain by impacting the expectation of pain, the attention toward the painful stimuli, and the overall emotional and psychological response toward the pain.

Using mindfulness techniques can be incorporated in your recovery journey which is in line with this holistic approach of improving overall wellbeing.

Exercises that also aid the journey toward increased mindfulness include gentler modalities such as Clinical Pilates, which focuses on strengthening breath control and forging the mind-body connection whilst also taking the injuries and limitations of patients into account.

Conclusion

To sum things up, it is absolutely crucial, when treating cases of both acute and chronic pain, to adopt a more holistic approach. Often, reported injuries and conditions are psychosomatic, in other words, caused or aggravated by a mental factor such as internal conflict or stress.

A major key to success in addressing these aspects would involve a cognitive-behavioural analysis and screening, the collaboration towards a change plan with the patient, and implementation of such a plan with guidance from the physiotherapist. This can only be achieved through the deliberate integration of both physical and psychological components of pain care, and naturally also requires a great deal of empathy and rapport building ability from the therapist.

If you are looking for a more holistic approach like the one described above in your journey towards a more pain free lifestyle, feel free to get in touch with us anytime!

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