According to the Medical Expenditure Panel Survey there are 100 million individuals over the age of 18 living with chronic pain in the United States! The 2008 survey included individuals who reported experiencing “severe pain,” “moderate pain,” “joint pain,” “arthritis,” “or functional limitation that restricted their ability to work.” Darrell J. Gaskin, Ph.D. and Patrick Richard, Ph.D., M.A. used this survey to estimate the economic cost of pain in the United States of America in their publication Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.  The end result of their research, after factoring in lost productivity and health care costs, estimated the 2010 cost of pain to be 560 to 635 BILLION dollars!

Not surprisingly, many of the primary complaints tracked by the National Health Interview Survey are conditions massage therapy is known to help alleviate, including severe headaches, neck pain, lower back pain, and face and jaw pain. Study after study has shown that therapeutic massage can promote relaxation, diminish the perception of pain, reduce anxiety, and reduce muscle spasms. As the amount of both research and experiential evidence supporting massage as a viable pain management strategy has grown, so has the number of consumers utilizing massage as part of their health care plan.  Massage is being accessed in hospitals, private offices, treatment clinics and as part of home care.

As we know, each case and every individual’s experience of pain is different. Therapists need to proceed with caution, considering each client’s specific complaints and diagnoses prior to treatment.  Chronic pain clients tend to be more sensitive to structural change than clients who are not experiencing chronic pain. They also tend to have a higher level of “body armor” and often require the therapist to work slower and can take longer to build touch trust.

Therapists working with acute and chronic pain clients can maximize the depth and value of their client/therapist pain management relationship by taking a few simple, yet vital steps.

  1. Never Stop Learning

There are a plethora of quality continuing education opportunities available to therapists who want to broaden their knowledge and understanding of “what” pain is and “how” our bodies perceive and process it, as well as, specific techniques for particular diagnoses.  There are also national and international pain symposiums that address the subject from a global perspective.  This coming week is the annual San Diego Pain Summit which offers a virtual presence option.

  1. Track Treatments
    Maintaining quality treatment notes is important for all clients, but infinitely so with clients who experience chronic pain.  This is true for a number of reasons, including multi-practitioner communication and legal protection, but an additional, often overlooked advantage, is to provide the client with a mechanism to “see” their progress.  Many clients who have experienced chronic pain have come to believe that they will never “heal.” They are resigned that pain is a part of their life and have accepted this as true.  As a result, these clients often have difficulty recognizing progress in their own treatment.  Being able to show them in their own words the difference between functioning today and what they told you 6 weeks ago can be very powerful.  I once had a client complain that he was frustrated that he wasn’t making any improvement.  I had already asked him what he did the day before and he had told me he walked the dog around the block.  After hearing his complaint, I pulled his file and showed him his intake form where he had stated that he couldn’t walk to his mailbox without experiencing extreme pain.  In that moment he connected with how much he really had improved, stating “I barely hurt after walking the dog!  Wow! That is great!”  His perception was that he had no improvement, when in reality he had experienced tremendous improvement.
  2. Build Community
    Get to know other practitioners who work with your potential clients.  This allows you an opportunity to vet practitioners that may benefit your clients or who may be potential referral sources for your practice.  Physical therapists, chiropractors, dentists, and personal trainers all make great members to your wellness community.

Chronic pain treatment is a diverse and complicated endeavor and should not be taken lightly.  These clients have experienced innumerable challenges and disappointments.  Therapists need to be focused, compassionate and client centered in their work.  It is important to work slowly and monitor the client’s reactions to the therapy, both during and after the session.

Please share your experience working with chronic pain clients!  What steps have you taken to prepare yourself for this type of work?  What classes have you taken that you would recommend to other therapists? What tips can you share that have been effective in helping you build your practice?  We want to know!