Tracey Pons MHealSc(Distinction)PGDipHealSc(Distinction)BSc(Physio)MPNZ MNZPS

Registered Physiotherapy Specialist, Pain Management Physiotherapy, Kaiapoi, NZ

Tracey is a Registered Physiotherapy Specialist and works in her private Pain Management Physiotherapy practice in Kaiapoi. She is also enrolled with University of Otago’s Doctoral programme with a longitudinal study across the South Island about the outcomes of Physiotherapy for Complex Regional Pain Syndrome. She was awarded a Master of Health Sciences, with distinction, in 2012 and was also awarded the Barrie Tait prize for highest academic achiever for the Post Graduate Diploma in Health Sciences in 2008. More recently, in 2016 she was the runner up for the Broadfoot Prize with the NZPS. She has six international publications about her clinical research with Complex Regional Pain Syndrome as well as beliefs and functional ability.

The Assessment of Persistent Pain 

The difficulty with the current method for the assessment of persistent pain is that current expensive or invasive diagnostic tools have been shown to be associated with complications, greater expense and do not consistently improve outcomes for treatment. It is being proposed in the literature that the assessment of persistent pain focusses on a systematic approach with a mechanism-based target for treatment instead. This involves, firstly, to identify the pain state; either nociceptive, inflammatory, neuropathic, nocipathic/dysfunctional or a combination. Secondly, the likely mechanisms involving psychosocial, sensitisation or physical functioning problems are then explored. Psychosocial mechanisms involve beliefs (appraisal and thoughts), behaviours, mood or social elements; Sensitisation mechanisms can be regional or central; Physical functioning mechanisms may be related to posture or movement patterns as well as issues of cortical reorganisation like sensory motor integration, tactile acuity problems, laterality recognition, imagined movement association with pain, or the lack of inhibition of primitive reflexes. The collated information provides the evidence to identify the likely targets for treatment where best practice guidelines show more effective outcomes if treatment takes care of the whole person, taking into consideration the life environment and relationships with caregivers or family. In New Zealand, completion of the electronic persistent pain outcomes collaboration (ePPOC) questionnaires are now mandatory for all persistent pain assessment. These cover most domains for an easily administered and comprehensive mechanism based assessment.

Physiotherapy for Persistent Pain 

Physiotherapy is essential in the multi modal and multi-disciplinary approach to manage persistent pain. An effective assessment is essential to identity the appropriate target for treatment. Evidence is overwhelming for the benefits of movement and active exercise. However, for persistent pain a) what exercise or intervention method to apply b) how to apply the prescription of effective physiotherapy interventions for specific targets are sparse. Clinical practice shows a broad variety of interventions are available and are applied concurrently, not sequentially. Patient centred goals aim to improve understanding, restore function to optimal level, normalise the central threshold to nociception, facilitate self-efficacy, restore coping ability, normalise everyday activity level. Understanding pain mechanisms is a cornerstone for both Physiotherapist and patient where education is essential. The prescription of exercise with an algorithm of either graded or pain exposure accompanied with mirror exercise, sensory motor training, exercise in water, graded motor imagery, TENS or psychological and problem solving techniques can be used effectively for positive treatment outcomes.