Pain is a normal part of life. We all experience it from time to time and in varying degrees. Pain is necessary for survival. What is important to understand is the difference between acute pain and chronic or persistent pain. The purpose, causes and management of the two are vastly different – and treating chronic pain as if it were acute can be futile or even worsen the problem.
The crux of the STEPP program is education. There are no silver bullets or magic fixes – but there is solid evidence to show that understanding ‘why’ we hurt will also help treat your pain. It will be hard work on your part and require patience and perseverance. At times you will probably want to give up. There are no guarantees that your pain will reduce, but it is an expected side effect. You will learn the current knowledge on how the brain processes pain, and how this can be turned into techniques (such as graded motor imagery GMI) that assist to desensitizing hypersensitive pain connections. When the pain response doesn’t turn on so easily, you can start to set functional goals and your activity can be slowly increased. Knowledge of how to manage chronic pain and associated symptoms (eg anxiety) will also assist you to re-engage with life and reduce the suffering associated with your pain (cognitive behavioural therapy CBT).
As you progress through the treatment sessions in conjunction with the STEPP manual, we will deal in detail with various components. Your pain is unique – so the extent that you have to work on the different components will vary. Some ideas and activities may seem unusual – but an important part of the program is to understand the reason behind why you need to do them.
The STEPP program will give you tools to manage and understand your pain, and change the impact that ongoing pain is having on your life. Skills that will help you to stand back and see the bigger picture, and know what course of action to take. Skills that encourage you to think in a way that explores all the factors contributing to your pain, not just a simple cause and effect. Skills that encourage you to seek an active re-engagement in life, rather than a fruitless search for passive answers. Lifestyle changes that help you move towards wellness. This requires deeper learning and effort on your part. There will be activities for you to do during sessions as well as homework to be done. No one else can do this for you. The value you get will be largely dependent upon your commitment and perseverance.
It is probably a good time to remind you of the old Pantene shampoo advert (you know, the one with Rachel Hunter) – “It wont happen overnight, but it will happen”. When you consider how long your body has had to adapt to ongoing pain – many months or years – it is going to take some time to go back the other direction. Chronic pain management isn’t a 2,4 or 6 week program. It is more like a 2,4 or 6 month one. And maybe even longer. Improvement is likely to be gradual. You will have flare-ups (but you will know how to manage them).
What is involved?
All clients are initially seen by the psychologist and physiotherapist at the same time. This is a required part of the STEPP program which allows comprehensive assessment of an individual and their unique situation. It allows thorough case formulation and planning. You are then have a separate physiotherapy and psychology assessment. This is required to establish your current functional status and history, develop baseline measures and highlight the direction for management. The extent of this assessment is dependent upon whether a 3rd party (such as an insurer) requires specific reporting.
STEPP is a program that can be tailored to meet the needs of the individual client. It consists of both physiotherapy sessions and psychology sessions that complement each other. Not all sessions will apply to all clients. Some may depend on whether the program is being funded by and insurer and return to work strategies need to be included.
The physiotherapy program will start with education sessions that are based on the text “Explain Pain“. This is a great textbook to have and can be purchased either as a book, for iPad or as an audio series. You will be given the information in a manual that covers all the sessions, but having a text to refer to that explains it in another way is a great resource:
Solid evidence now shows that knowing why we hurt will help us heal. All pain is real, and for many people it is a debilitating part of everyday life. In a world where 1 in 5 of us experience ongoing pain and where there is increasing evidence for the failure of synthetic drugs, take heart: help is at hand. It is now known that understanding more about why things hurt can actually help treat pain Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain Second Edition discusses how pain responses are produced by the brain, how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal. Co-author Dr David Butler, founder of the Neuro Orthopaedic Institute, says that "it is no longer acceptable that pain be just managed: we must expect that it can be treated, and sufferers can alter it themselves through education." Explain Pain has sold around 60,000 copies world-wide in 5 languages and continues to inspire clinical research and multidisciplinary pain treatment globally. Explain Pain aims to give people in pain the power to challenge pain and to consider new models for viewing what happens to your body and brain during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery.
Once you have a handle on the neuroscience underpinning the pain you currently have, the program moves on to techniques to help desensitize your nervous system, and start to upgrade the physical activity that you can do. This is likely to include some GMI sessions and then developing an appropriate physical upgrading program.
The psychology program will involve dealing with all those other issues that go hand in hand with persistent pain. Pain is not the only issue – there are lots of other factors that add to the associated suffering. This is an individual recipe. Things you struggle with may be different to someone else. What we do know though, is these things are contributing to your chronic pain experience. If you want to change your pain, you have to modify all the input variables.
There has been a growing demand for services for people who do not live locally. There is the opportunity to complete the course via Skype video linkup. We are happy to discuss this with you.
UPP (understanding Persistent Pain) is a basic education physiotherapy course in managing persisting pain for patients. It is a preventative strategy for those patients who have started to deteriorate into chronic pain patterns, or are at risk of doing so. It is a short one-to-one course that does not involve any individual assessment or treatment. It is not a substitute for the STEPP program – which is an individually tailored and comprehensive multidisciplinary program that educates and treats those who are experiencing entrenched chronic pain syndromes and need intensive assistance to move forward. UPP is based around 5 standard physiotherapy sessions, and some clients may be able to accessing some funding under Medicare Chronic Disease Management program if their GP considers that it is an appropriate referral.
So – here is the point where you decide if you want to commit and push on to explore how education and understanding your pain better can equip you to improve your function quality of life. If you are ready to explore some new pain management strategies:
- Give us a call and leave a message at 0437 575 407 or 0478 045 617 or preferably send us an email at email@example.com and we will get back to you shortly.
- Go and talk with your GP. They need to be on board and write you out a referral for services.