In the United States, we are facing a pain epidemic. An excess of 100 million people in this country currently experience chronic or persistent pain, defined as pain without apparent biological value that persists beyond normal healing time (approximately more than three months). For many years, the response to persistent pain was medication, often through use of highly addictive and potentially deadly opioid medications. However, the consequences of those strategies are now painfully obvious. Patients continue to look for solutions to their pain, while health care providers struggle to simultaneously help patients and avoid the frustrations of a complex and ever-evolving medical system. What is left is a conundrum that leaves both patients and their practitioners frustrated over ineffective solutions to pain issues, effectively reducing the chances for both short- and long-term success with treatment.

In our first article, you heard about the general concepts of Shared Decision Making and can probably see its potential to positively impact the future of healthcare. Many now herald physical therapy as a practice of choice for both appropriate and safe treatment of pain. But why are physical therapists so well positioned to help those in pain?

Physical therapists understand that pain and function are two different concepts. When we focus on understanding pain while simultaneously assisting patients back to doing what they love or need to do, pain often subsides. A theory toward pain and function was published in 2014 by the late Louis Gifford, a world-famous pain scientist. Those seeking more collaborative care can work together with their physical therapist to gain better control of their pain, and more importantly, their life and general function, by seeing their recovery as a two-phase approach. This is the essence of Shared Decision Making — patients and providers collaborating on the best plan and the desired outcomes.

Phase 1: Get a handle on pain (Fig. 1)
New approaches in pain treatments focus on appropriate education and understanding the nature of the patient’s problem, including understanding the body’s complex pain systems. As healthcare providers, physical therapists must understand the patient’s experience; their thoughts, beliefs, past knowledge, coping strategies, and fears or anxiety relating to their pain. On the other side, patients must understand how their physical therapist is going to approach problem solving and their own thoughts, beliefs, and background to achieve optimal treatment success.

Shared Decision Making

Figure 1

Phase 2: Despite the pain, move on with life (Fig.1)
In Phase 2, physical therapists and patients must work hand-in-hand to accomplish the common goal of returning the patient to his or her previous activities, sometimes “despite the pain.” From what was learned in Phase 1, physical therapists collaborate with their patients on setting specific, patient-centered goals; developing a plan to help patients return to their activities at the most appropriate pace; and helping determine when a patient is ready to move to an independent program. This is a key factor in determining long-term patient pain outcomes.

Physical therapists are “team players” in the medical world
Often operating in multi-disciplinary settings or as independent practitioners, physical therapists seek collaborative opportunities with a team of health care providers involved in a patient’s care. Just as importantly, physical therapists often see themselves as entering into a partnership with every patient they encounter. Thus, patients and physical therapists work together to address complex problems with pain and physical dysfunction through collaborative goal formation and revision. They will ultimately attain several key long-term outcomes, including independence, self-management of pain, and physical therapist growth and learning.

When we look at these factors, the relationship between patient and physical therapist, particularly when treating pain, is a collaborative experience that relies heavily on commitment and a positive partnership. Through this process, growth from both the patient and the physical therapist is evident. As we utilize Shared Decision Making, we grow together and can ultimately accomplish great things — including stopping the progression of the pain epidemic and improving the health and wellbeing of our society.