Chronic pain, complexity and a suggested role for the osteopathic profession

IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Hannah Naomi McDonald , Toby Joseph Lowe
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引用次数: 0

Abstract

Chronic pain is common and has a substantial impact on individuals’ lives and the society in which they live. However, current strategies for managing chronic pain have low to moderate efficacy. We present a complexity informed model of managing chronic pain.

The authors propose that the biological, psychological and social factors influencing the experience of chronic pain can be framed as elements of a complex system (when ‘system’ is understood as a mental model of a set of relationships in the world) and discuss the advantages of this approach.

The ‘Learning Cycles’ framework of Human Learning Systems is suggested as an appropriate approach to managing chronic pain. There are five elements of the Learning Cycle; ‘understanding the system’, ‘co-design’, ‘experimentation exploration’, ‘embedding and influencing’ and ‘system stewardship’. The authors describe how this could be implemented in osteopathic practice.

The implications of a complexity approach with respect to evidence-informed as opposed to evidence-based practice is briefly discussed. Further, the opportunity for osteopathy to be at the vanguard of broader movement for change in public service and healthcare is highlighted.

Applying Learning Cycles to the context of managing chronic pain requires further research to explore its utility. Learning Cycles provide an action-research model that would supply the rich data by which to understand the efficacy of chronic pain management.

Implications for practice

  • Using a complexity informed approach (Human Learning Systems' Learning Cycles) in the management of chronic pain.

  • Structured and efficient way of providing a co-produced, person specific approach to practice.

  • Practical way of incorporating biological, psychological and social factors influencing the person's experience of chronic pain into management, without assuming causal weighting.

  • Epistemological implications for research and the current understanding of hierarchy of evidence.

慢性疼痛、复杂性和建议骨科专业发挥的作用
慢性疼痛是一种常见病,对个人生活和所在社会有很大影响。然而,目前管理慢性疼痛的策略效果一般。作者提出,影响慢性疼痛体验的生物、心理和社会因素可被视为一个复杂系统的要素(当 "系统 "被理解为世界上一系列关系的心理模型时),并讨论了这种方法的优势。学习周期有五个要素:"了解系统"、"共同设计"、"实验探索"、"嵌入和影响 "以及 "系统管理"。作者描述了如何在整骨疗法实践中实施这一方法,并简要讨论了复杂性方法对循证实践的影响。此外,作者还强调了整骨疗法在更广泛的公共服务和医疗保健变革运动中充当先锋的机会。将 "学习循环 "应用于慢性疼痛管理需要进一步的研究,以探索其实用性。学习循环提供了一个行动研究模型,可为了解慢性疼痛管理的有效性提供丰富的数据。对实践的启示--在慢性疼痛管理中使用复杂性方法(人类学习系统的学习循环)--以结构化和高效的方式提供共同生产的、针对个人的实践方法--将影响慢性疼痛患者体验的生物、心理和社会因素纳入管理的实用方法,而不假定因果权重--对研究和当前证据等级理解的认识论影响。
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来源期刊
CiteScore
2.20
自引率
36.80%
发文量
42
审稿时长
3 months
期刊介绍: The International Journal of Osteopathic Medicine is a peer-reviewed journal that provides for the publication of high quality research articles and review papers that are as broad as the many disciplines that influence and underpin the principles and practice of osteopathic medicine. Particular emphasis is given to basic science research, clinical epidemiology and health social science in relation to osteopathy and neuromusculoskeletal medicine. The Editorial Board encourages submission of articles based on both quantitative and qualitative research designs. The Editorial Board also aims to provide a forum for discourse and debate on any aspect of osteopathy and neuromusculoskeletal medicine with the aim of critically evaluating existing practices in regard to the diagnosis, treatment and management of patients with neuromusculoskeletal disorders and somatic dysfunction. All manuscripts submitted to the IJOM are subject to a blinded review process. The categories currently available for publication include reports of original research, review papers, commentaries and articles related to clinical practice, including case reports. Further details can be found in the IJOM Instructions for Authors. Manuscripts are accepted for publication with the understanding that no substantial part has been, or will be published elsewhere.
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