{"title":"慢性疼痛、复杂性和建议骨科专业发挥的作用","authors":"Hannah Naomi McDonald , Toby Joseph Lowe","doi":"10.1016/j.ijosm.2024.100724","DOIUrl":null,"url":null,"abstract":"<div><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p></div><div><h3>Implications for practice</h3><p></p><ul><li><span>•</span><span><p>Using a complexity informed approach (Human Learning Systems' Learning Cycles) in the management of chronic pain.</p></span></li><li><span>•</span><span><p>Structured and efficient way of providing a co-produced, person specific approach to practice.</p></span></li><li><span>•</span><span><p>Practical way of incorporating biological, psychological and social factors influencing the person's experience of chronic pain into management, without assuming causal weighting.</p></span></li><li><span>•</span><span><p>Epistemological implications for research and the current understanding of hierarchy of evidence.</p></span></li></ul></div>","PeriodicalId":51068,"journal":{"name":"International Journal of Osteopathic Medicine","volume":"53 ","pages":"Article 100724"},"PeriodicalIF":1.1000,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Chronic pain, complexity and a suggested role for the osteopathic profession\",\"authors\":\"Hannah Naomi McDonald , Toby Joseph Lowe\",\"doi\":\"10.1016/j.ijosm.2024.100724\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p></div><div><h3>Implications for practice</h3><p></p><ul><li><span>•</span><span><p>Using a complexity informed approach (Human Learning Systems' Learning Cycles) in the management of chronic pain.</p></span></li><li><span>•</span><span><p>Structured and efficient way of providing a co-produced, person specific approach to practice.</p></span></li><li><span>•</span><span><p>Practical way of incorporating biological, psychological and social factors influencing the person's experience of chronic pain into management, without assuming causal weighting.</p></span></li><li><span>•</span><span><p>Epistemological implications for research and the current understanding of hierarchy of evidence.</p></span></li></ul></div>\",\"PeriodicalId\":51068,\"journal\":{\"name\":\"International Journal of Osteopathic Medicine\",\"volume\":\"53 \",\"pages\":\"Article 100724\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-04-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Osteopathic Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1746068924000178\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Osteopathic Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1746068924000178","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Chronic pain, complexity and a suggested role for the osteopathic profession
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.
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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