Alternative Therapies for Pain Conditions

Introduction

Traditionally Physical / Physiotherapists are taught to be 'hands on' therapists and use traditional methods such as manipulations and soft tissue mobilisations, wether your in the camp of McKenzie or Maitland can be influenced upon your training. There is a lot of eveidence to sugesst that our traditional methods of treatment aren't effective at managing persitent pain long term, so is it time to look outside the box at alternative methods? 

Mindful Meditation

Pain is not just a pathophysiological process which was once though, it is an experience that is individual and unique to everyone. Pain is linked to experiences and memory, emotions and perceptions and social expereicnece, therefore when treating persistent pain that is as complex as this, are 10-15 minuites of 'hands on' treatment going to be effective? 

Studies have shown a positive effect when looking at the effect of Mindful Meditation and persistent pain. Mindfulness / Mindful Meditation is defined as influencing the styles of thinking and emotional coping strategies, which aims to change unhelpful beliefs and catastrophising thoughts. 

Mindfulness is said to involve moment - moment attention to stimuli, whether this is external or internal, such as thoughts and feelings. It is acknowledgement of these stimuli with a non-judgemental view. This is a skill, which needs to be practiced. Studies of Budhists and Monks have been shown to display changes in the brain which is thought to be related to their Mindful Meditation, but as stated this is a skill in which they develop and practice for months and years, so how can this be effective with our persistent pain population? 

There are many different types of meditation which can argue different techniques but it can be suggested that the Phases of Mindful Meditation are:

Inital Phase:

This is concerned with the focused attention which can have effect of the selective and executive attention. This phase can involve focusing on the breath and the sensation of the air entering and exiting the body. 

Intermediate Phase:

Acknowledging the wandering mind and distractions, making note of them and bringing the mind back to focus. At this stage this is an effortful practice 

Advanced Phase:

This phase is a continuum of the intermediate phase, where this process become less effortful. 

Working with this theory on different phases /stages of meditation and given the length of time it takes to become an advanced meditator (like the Budists and Monks) and the criticism through out the litrature on the short duration of controlled trials we can come to the conclusion that our patients have the capacity to enter the inital / intermedite phases. 

Research that is available does suggest that the less mindful the individual the more they catasthrophised, which involves the attention on the painful stimuli and is interprested as a potential dangerous and harmful experience, in comparison to the mindful individual who catastropises less and each sensation / stimuli is observes as a non-judgemental sensation. 

So how do we empower our patients with theses skills? There are groups they could attend or simple online programmes to follow: 

Yoga

The NICE guidelines have been updated and recommend the best treatment for low back pain is exercise and not hands on treatment. Anacdotally we known that a large proportion of persistent pain sufferers have back pain, and have tried many different treatment options previously, including hands on physiotherapy and have been given exercises at some point. So what is the best form of exercise for these patients? Some research has suggested that Yoga may be beneficial. 

So what is Yoga? It is an ancient practice that dates back over 5000 years. There is much more to Yoga than aiming to achieve those distorted and extreme positions that are associated with Yoga. It is also about harmonizing the body and mind with the breath (similar to the focused attention in the early phases of meditation). 

Pearson 2008