A Multi-disciplinary Approach to Pain

1. Rene de Ruiter January 2011 Contact: Blenheimphysio@actrix.co.nz A Multi-disciplinary Approach to Pain

2. physiotherapist since 1983 ( 27 years) Background

3. Progressive Goal Attainment Program 10 week duration 10 x 1 hour sessions with the help of instructor client sets goals client follows work book based on psychology individual PGAP

4. Functional Reactivation Program 6 weeks program 3x1 hour session per week guided by physiotherapist based at clinic, gym, pool or athletic park reports after assessment, 3 and 6 weeks pain is the main issue extensions to 12 weeks if needed physical, individual FRP

5. The FRP approach is based on Cognitive Behavioral Approach Graded Exposure Evidence based practice for chronic pain FRP

6. Physical Fitness for Work and Independence lack of fitness, post surgery 6 weeks program guided by physiotherapist based at clinic, gym, pool or athletic park reports after assessment, 3 and 6 weeks extensions to 12 weeks if needed physical, individual PFWI

7. single, lives with mother not able to work because of chronic pain depressed in need of more operations: hips and low back had surgery on both knees poor life style choices: smoking, diet coke,more than 4 coffee, no exercise, no water intake, over 100kg sister committed suicide, father died young Jan, 25 year old female (FRP)

8. Tampa Scale of Kinesiophobia McGill Pain Questionnaire Pain Disability Index Pain Catastrophizing Scale Jan's scores:

9. Test Scores

10. to be able to cycle 10 km/ 30 minutes to be able to sit down/ stand up/ sit down from the floor to be able to lift a small child, i.e. to be able to squat 25 kg Jan's Goal Priority Questionnaire

11. Goal 1 To be able to cycle 10 km / 30 min

12. Goal 2To be able to sit down/ stand up

13. Goal 3To be able to lift a small child

14. Aerobic Exercise Strengthening Flexibility and Range of Movement Education Home Exercise Program Jan's 6 weeks gym program

15. Strengthening walking stairs from 5x to 12x core strength from 3 to 4 squatting from bar only to 20 kg Jan's 6 weeks gym program • Aerobic Exercise • treadmill walking from 5 min to 30 min • power walking from 5 min to 30 min • exercycle from 5 min to cycle for transport

16. Education posture pain education pain management lifestyle choices movement patterns Jan's 6 weeks gym program • Flexibility and Range of Movement • muscle stretching • active joint mobilisation • nerve mobilisations

17. Jan's 6 weeks gym program • Home Exercise Program • instruction, correction, progression • motivation • goal setting

18. The more tests Jan will have, the more this could emphasize that something is wrong. Waiting times also delay rehabilitation. Tests

19. It is not uncommon for a client like Jan to have had: x-rays, C.T scan, MRI, US scan, orthopedic review, psychologist review, dietitian review physiotherapist review, occupational therapist review, occupational physician review, functional capacity evaluation, workplace assessment Tests

20. Pain facts • Pain is your body talking to you • Pain is a request for help • Pain is a messenger, don't shoot it • We can't see pain • Everybody experiences pain from time to time

21. Pain facts • Why does pain stop some people from living life to the fullest? • What are you doing about it?

22. financial or emotional dependence on pain: no pain – no gain uncertainty about a future without pain difficulty pacing and loading over-enthusiasm or overdoing it at the start of the program expectation of immediate results Influences to the outcome

23. On the last day of Jan's life, I want her to be able to look back, and say: I have no regrets. I had a great life. If I had another go, I'd do it all the same. Looking forward

24. Jan was on her way to becoming a sickness beneficiary. Improving fitness and attitude to life will hopefully lead to a return to the workforce and restoration of quality of life. Reflection

25. Know pain – know gain