Pain and Associated Distress

• Therapeutic Alliance:

  • seeing the person
  • fostering autonomy
  • sharing the journey
  • therapeutic touch
  • communication
• Building the alliance:

  • Taking time
  • Hearing the patient
  • Letting go of assumptions
  • Understanding what change would mean for the patient’s life
  • Empathy and openness
• Barriers to building alliance:

  • Holding tight to sense of self as the expert
  • Pressure to fix the patient
  • Accidentally undermining patient autonomy
  • Determining outcomes without the patient’s involvement
  • Closing down patient distress
• Work and meaningful activity:

  • Acute low back pain - work-disability at 3 months an indication of long-term disability
  • Recovery expectancy and the role of clinical messages
  • Self-efficacy
  • Catastrophisation
  • Mood disorders
• Take Home Message:

  • Hear the patient – they have all the information you need
  • Take time to build a relationship with the patient
  • Support the patient to explore changes they would like to make
  • Link exercise to doing the things that matter – family, work, relationships, social life
  • Support the patient to experiment
  • Often…It ain’t what you do, it’s the way that you do it