Osteopathy for Chronic Pain

Young man with back pain

As “back specialists”, osteopaths see large numbers of patients with chronic pain, and this type of pain is far more challenging to treat than pain which has only been present for a few weeks.

What is chronic pain?

Have you been in pain for more than six months? If you have, then you are officially classified as suffering from chronic pain. However for in some cases the pain may persist for many years. For some people it may result in loss of their job and others may find they are no longer able to do many ordinary day-to-day tasks such as cooking, cleaning or gardening. Chronic pain affects 40% of the UK population, and it is more common among women than men(1). Although low back pain and sciatica accounts for a large proportion of chronic pain, it may also affect the upper back, neck and shoulders, or the hands.

If you have been in pain for a long time you may have tried pain-killers, physiotherapy, acupuncture, and many other treatments. But after all this time, how well do you understand the mechanisms underlying your pain? We now know that patients who understand pain have a better prognosis than those who do not. This finding has given rise to a new approach to the treatment of chronic pain, known as Explain Pain, where the therapist spends time helping the patient understand how pain works.

These methods work because pain is actually an experience produced by the brain. I like to use the analogy of a smoke alarm. A smoke alarm is designed to ensure that the occupants of a building are alerted in the event of a fire, so that they can either put the fire out or make a timely escape. Pain is also an alarm system, which goes off if we injure ourselves. However smoke alarms are notorious for going off when we simply burn the toast or a crumpet. And sometimes our pain alarm goes off when we have a very minor injury such as a paper cut.

In the case of chronic pain, the alarm becomes over-sensitive, and goes off at the slightest provocation, rather like the smoke alarm going off when the crumpets aren’t even burnt. So in treating patients with chronic pain it is necessary to desensitise the pain alarm, and this involves working with the brain.

Notes:

1. ‘Silent epidemic’ of chronic pain affects nearly 28 million in UK, study suggests, the Guardian, June 21st 2016

Osteopathy for chronic pain

My approach to the treatment of chronic pain incorporates the Explain Pain approach, alongside conventional hands-on treatment and the use of mindfulness-based exercises to help the patient get their pain under control.

Secondly patients will recover better if they can be encouraged to fear pain less and do more. So part of my role as an osteopath is to help my patients to be less fearful and to try doing some of the things they have stopped doing because of their fear of pain. A gradual increase in gentle activities can bring about changes in both the brain and the body which reduce the sensitivity in the brain and thus lead to reductions in pain levels.

Nonetheless there is always work to be done on the tissues. Even though the original injury may have healed, there will still be some tissue changes which need addressing particularly if the patient has developed compensatory patterns. For instance muscles may have shortened, or the patient may have have adapted their posture and gait because of the pain. All of these changes will respond to hands on osteopathic treatment combined with tailored stretches and exercises.

BrainWorks

For those who wish to commit to a programme of treatment which utilises the most up-to-date approaches to working with chronic pain, I am now offering BrainWorks. The new BrainWorks programme is a six week course of one-hour sessions which incorporate Explain Pain, Graded Motor Imagery and the use of mindfulness exercises.

The programme also draws on OsteoMAP which was developed at the British School of Osteopathy with a grant from the Department of Health. OsteoMAP, which combines osteopathy with mindfulness and ACT (Acceptance and Commitment Therapy), is an integrated physical and psychological approach which aims to help patients develop mindfulness-based self-care skills to manage discomfort more effectively themselves. ACT aims to enable patients to accept where they are at the moment, to commit to living a life led by their values rather than one controlled by the pain and to find ways of living more active, personally meaningful lives despite pain.

By combining mindfulness and ACT with the desensitisation approaches of Explain Pain and Graded Motor Imagery, the BrainWorks programme aims to bring about a reduction in the intensity of pain, as well as releasing the patient from feeling controlled by it.