Student work: Ethics of working with clients in chronic pain by Thomas Fonder

Michelle Burns
September 13, 2016

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
The article "The Painful Truth, Helping Clients Manage Chronic Pain," by Mark Liskey, in the November 2015 issue of Massage & Bodywork, addresses the ethical dilemma in dealing with clients whose problems cannot be resolved by manual therapies alone nor by any other means as well. These are cases that can really only be managed and/or co-managed, not "cured."

Liskey discusses the various pain models that people may employ to cope with chronic pain and how to recognize them in your clients. He discusses then how to deal specifically with each psychological coping mechanism so as to ensure the most refine and effective treatment plan.

It was enlightening to learn that there were different perceptions of pain and responses that people utilize/embrace to deal with their chronic problems. And in order to be successful, the therapist's approach when interceding needs to be tailored more specifically to the pain model in which the client is operating.

In most of these cases only pain relief, not a "cure," can be the aim of treatment and it is unethical to promise a goal that is unrealistic or unattainable. It is our responsibility to help direct the client to the most positive outcome and not to inadvertently impede or interfere with improving their quality of life. Not recognizing a pain model can have negative biopsychosocial effects.

Depending on the pain model, the therapist may need to support massage with strategies ranging from self-massage instruction, ergonomic advice, encouraging functional activities that don't trigger/exacerbate symptoms, to referring to vetted healthcare professionals within the area (diagnosticians, counselors, psychologists, pain-control specialists, etc.) when a case progresses outside their scope of practice.

In my practice, I hope to be more cognizant of the above factors in dealing with people who have been diagnosed with chronic conditions. It brings home the importance of establishing a network of health care professionals that I can feel comfortable referring to and with which I can co-manage cases. It also actually reduces the pressure of attempting to manage these difficult cases alone. Treatment outcomes are more likely to be positive if the physical, psychological and behavioral components are all considered.

Acknowledging, recognizing, and understanding the various chronic pain models and their varying behavioral impacts can help guide the therapist in how best to direct treatment and help improve the client's overall quality of life, even if he/she can not completely eliminate the pain.

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