Understanding the roles of healthcare professionals

This chapter aims to help you understand more about:

•   The roles of healthcare professionals, including physiotherapists, specialist pain nurses, pain specialists, psychologists and psychiatrists, in managing chronic pain

•   How talking therapies, including Cognitive Behavioral Therapy, can help with chronic pain

•   How pain management programmes work

Healthcare professionals

This chapter looks at the different healthcare professionals who may be involved in helping you to manage your pain better. Most of them will be highly trained in their own speciality and be very experienced in dealing with many aspects of pain.

Pain affects the whole person, so a ‘multi-disciplinary’ team with the expertise from different professions, working together can be very helpful. For example, a physiotherapist or a pain specialist doctor might provide acupuncture sessions, and the physiotherapist, psychologist or pain nurse might teach relaxation and pacing skills! They all help people with managing pain, and support their families and carers. Some other professionals may be involved and their roles are not described in detail here – for example, occupational therapists, art therapists, and doctors with different specialities.

What is the role of a physiotherapist?

A physiotherapist has specialist knowledge and experience of the musculoskeletal system, the pain system and how the nerves, bones, muscles and tendons, joints and ligaments work together. So physiotherapists understand the way the physical body works to allow movements such as walking, bending down or riding a bike. They can identify problems if you have difficulty making certain movements, or if you have pain or other symptoms such as lack of balance or recurring falls.

Physiotherapists have no training in using drugs to manage movement or pain problems. They do not prescribe any form of drug treatment.

If you have chronic pain, physiotherapists will know how it’s likely to affect your physical activity and fitness levels in the long term. They will be able to show you a range of activities or exercises in order to gradually increase your stamina, strength and flexibility. They will also help you to learn useful skills, including how to:

•   Pace your daily activities (see Chapter 8)

•   Set goals in order to achieve things (see Chapter 6)

•   Solve problems (see Chapter 10)

•   Manage setbacks (see Chapter 16)

•   Use relaxation techniques to manage your pain better (see Chapter 12)

How do physiotherapists work?

Firstly, they do a detailed assessment of your experience of pain. They will assess how it affects things like your daily activity, work, hobbies and sleep pattern. They may ask how and when the pain problem started, what investigations you have had, and what the results were.

Secondly, they do a physical examination, looking at how your musculoskeletal system is performing. They will assess your nerve function and mobility, muscle strength and length, the range of movement in your joints, and your reflexes and balance.

Thirdly, they tell you what is working normally and what parts of the musculoskeletal or movement systems require some intervention to help improve their function.

Fourthly, they may be able to help you plan ways to improve the way your body moves. This often means following a programme of different types of exercises, designed to improve flexibility, strength and stamina in your muscles, ligaments and tendons. These exercises can make it easier for you to carry out a range of physical activities in your everyday life, such as bending to put things away, or being able to walk further or have a better sex life. The aim is to help increase your self-confidence as well as your fitness.

Physiotherapists are trained to use specialist equipment and ‘hands-on’ manual therapy techniques. They are also often trained to use acupuncture and advise on the use of TENS (transcutaneous electrical nerve stimulation) machines. These machines are used for relief of pain. ‘Transcutaneous’ means ‘through the skin’, and the machine delivers small electrical pulses through electrodes placed on the skin. It can feel a little like ‘pins and needles’. This sensation can change the way that pain signals are sent to the brain. That is, it can close the ‘pain gate’. Around 50 per cent of people who try a TENS machine find that it can provide some pain relief while it is in use.

It may be helpful for you to see a private physiotherapist or for your GP to refer you to an NHS physiotherapy service. Before your first appointment, make a note of what daily physical activity problems you have because of your pain.