Effective communication is a known factor in creating a strong therapeutic relationship. Therapeutic relationships can facilitate patient adherence to therapy, satisfaction with care and improved outcomes; they have also been associated with reduced malpractice claims. This article addresses aspects of communication which are key to building therapeutic relationships in chiropractic practic
Chronic pain symptoms can be quite different from acute pain symptoms.1 One possible reason is sensitization, a process whereby neurons become more responsive to pain signals and/or translate non-painful stimuli into pain. Part 1 of this series described general neuro-adaptive processes leading to sensitization and clinical diagnostic criteria. Here in Part 2, management strategies for persons with sensitization are described.
Practitioners use symptoms to guide clinical evaluation and treatment. For example, chest pain on exertion suggests possible need for cardiac evaluation. Pain is a symptom we are trained to explore by asking questions such as, “How severe is your pain?” and “Where is the pain located?” We ask these questions because the answers help point us in the direction of a diagnosis. However, pain symptoms are sometimes unreliable. For people experiencing chronic pain, symptom characteristics may not match patterns found in acute cases. The physiological basis for this alternate pain experience can be the result of peripheral or central sensitization.
Chronic pain symptoms and the ability to manage and cope with them can be strongly influenced by what are generally referred to as psychological factors. These factors have the capacity to substantially hinder clinical improvement, cause symptom aggravation and reduce self-management capacity. Though these concepts are well-supported in the scientific literature, they are not inherently usable. Practical methods of revealing relevant psychological factors are needed. To explore whether psychological factors are clinically relevant, clinicians can ask questions during the consultation and/or use one of several screening questionnaires.
Research evidence suggests following guideline recommendations can improve quality of care and clinical outcomes. However, translating recommendations into clinical care for individuals can be challenging because guidelines, by nature, tend to inform care on a general level. Further complicating guideline adherence is confusion caused by inconsistent terminology and the existence of multiple guidelines for single conditions, among other issues. Inconsistent recommendations within guidelines raises the question, “Is there common ground among guidelines for musculoskeletal conditions?” To answer this question, researchers identified 11 recommendations that consistently appear within current guidelines.
The biopsychosocial model is a widely recommended method of clinical evaluation and management. The model identifies three important areas. “Bio” refers to evaluating/treating biological problems (e.g., pathology), “psych” refers to psychological health, and “social” refers to a person’s relationships with others and the environment. However, some evidence suggests that practitioners, as a group, may not be addressing “social” components of health as much as they could.
Person-centeredness is an approach to health care focused on the person, placing high importance on things such as being respectful and responsive to individual preferences, needs and values. Practitioners who adopt this approach to care report that it can transform the doctor-patient encounter and even re-energize providers. The path to patient-centeredness, however, is not always a natural one for doctors, many of whom report that they must continually work to adopt and refine this style of patient care. Learn what you can do to begin moving toward a more patient-centered approach in your practice.
Part of the Evidence in Action series by Palmer College of Chiropractic
The concept of caring for the whole patient is not new. As early as the 5th century BC, Hippocrates described the importance of attending to the person behind the disease rather than the disease itself. He described psychological, social and physical elements that variously combine and contribute to a person’s health. Assessing and addressing all three components (biological, psychological and social conditions) contributing to health is called a biopsychosocial approach.