Have you ever noticed how we tend to develop subgroups or “cool kids clubs” whenever we find ourselves in large groups? Of course you have; after all what else are cliques and ‘gatekeeping’ if not evidence of our well-honed ability to perpetually form smaller and more exclusive group identities?
In the world of pain-based therapies this tendency has both limited the spread of knowledge and has detracted from the quality of care. Let’s get more specific. There exists a strange association between insisting upon a scientifically rigorous approach to clinical care and a tendency to restrict treatment options only for the sake of restriction. In other words the approach turns into a contest to have the most rigorous (aka restrictive) standards for appropriate treatment options.
After all, the practitioner who is willing to do utilize the smallest variety of options must have the highest standards for “evidence-based” care, right? Its an approach to practice that seems to emphasize the rejection of pseudoscience more highly than care that is truly patient centered. The consequence is this a culture which can only support a tiny and very uniform array of acceptable patient interactions.
And this is an unfortunate development because, as I have alluded to, these rules weren’t put in place in response to any patient demand. They were created by and for the community of evidence based pain therapists. Don’t get me wrong here, the reasons behind their existence are very valid. The rules exist because the community genuinely hopes that they will the patient experience. The problem is that things just don’t seem to play out to the intended effect. The history of humanity is a story of a pendulum swinging from one extreme to another and clinicians, coaches and therapists are no exception. But as with so much in life the truth is somewhere in the grey zone.
See, the degree of acceptance of and adherence to the patient’s desires for the direction and goals of care will powerfully predict the success of that care. But in my experience the patient’s EXPECTATIONS and the adherence to them is far more powerful. And despite the fact that patient empowerment, resilience and pain context are the most absolutely powerful pain relief methods that we have ever known, they aren’t enough.
Because the fact is this: the patient doesn’t expect that you are going to guide them on some kind of spirit journey and show them that “they had the power all along.” They are expecting that you are going to do a thing and after you do that thing that they will feel better. So it becomes extremely important to avoid coming right out the gate with “hey guess what, you have the power to make powerful, positive impacts on your own well-being and so we are going to empower you to do the bulk of the work!”
In the early 2000’s we all loved a good origin story. Batman Begins was first and then what followed was an unending parade of comic book hero reboots and origin stories. The familiar and, oh so very effective, formula of these stories is always the same: our protagonist is just trying to live their life. Then something dramatic happens. Now stay with me here. Because what happens next is that the movie takes some time to show us how they GRADUALLY come to grips with and accept the fact that they must master and utilize this new power. It took time for Peter Parker to understand what Uncle Ben meant by “with great power comes great responsibility.” Hell, Chris Nolan’s Batman technically took 3 movies to figure out who Batman is within the context of Gotham City.
But imagine we made a movie where Peter gets bit by a spider and the very next scene is Uncle Ben saying “Congrats Pete, you’re a spider-boy now! Get out there and start slapping around some criminals.” This is essentially what clinicians are doing to patients who show up for the purpose of relief and are then immediately told that pain relief will be a team effort but that the practitioner will spend most of their time simply cheerleading for the patient.
Patients present to a pain-care provider’s office for help. To pretend that our relationship with them is not based upon us giving them something that they could not otherwise attain is disingenuous and needlessly obfuscative. There will come a point when we need to give the patient an external “something.” We, an external force, will eventually have to intercede into the well-being of the person we are serving. This is both inevitable and appropriate.
I want to leave you with one last thought. And that is that not everyone within the biopsychosocial or evidence based approaches slams the pendulum all the way to to other side of its swing. There are some excellent healers and educators out there. So I want to give credit where credit is due.
Greg Lehman BKin, MSc, DC, MScPT – He has published what may be the greatest free resource for clinicians and patients alike. Go check out his recovery strategies guide and everything else he has to say including at his YouTube channel.
Ben Cormack D.P.T. – This is really more of a resource for students and clinicians but the resources through Cor-Kinetic may be the most well thought out among the ongoing conversation.
Jacob Harden D.C. – Dr. Harden is another great resource for recovery and rehab information. His Instagram account is loaded with actionable, relevant info for bridging the gap from movement based rehab to picking up heavy things and building strength safely.