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Developing a chronic pain self-management clinic at the British School of Osteopathy: Quantitative pilot study results
Abbey, H. [19]
Nanke, L. [5]

Journal: International Journal of Osteopathic Medicine Date: 2013/03, 16(1):Pages: e11-e12. doi: Subito , type of study: mixed methods study

Full text    (https://www.sciencedirect.com/science/article/pii/S1746068913000084)

Keywords:

fear-avoidance beliefs [2]
cognitive behavioral therapy [6]
chronic pain [204]
osteopathic manipulative treatment [2973]
OMT [2951]
mixed method study [52]

Abstract:

Background: Still's maxim ‘Find it, fix it and leave it alone’ is relevant for acute pain but osteopaths can feel challenged when managing chronic conditions unlikely to resolve with manual therapy alone. Research indicates that Mindfulness and Acceptance-based approaches, part of 3rd wave Cognitive Behavioural Therapy (CBT), are effective in addressing negative beliefs which maintain fear-avoidance behaviour and pain-related disability, improving outcomes by developing flexible responses to pain and enhancing patients' capacity to live more fully in accordance with personal values. Common ground between osteopathic concepts of function and ‘functional contextualism’ in CBT provided a rationale for developing a new osteopathic approach to chronic pain management and this study evaluated outcomes from a six week Acceptance-based course for patients at the British School of Osteopathy (BSO) Clinic. Methods A mixed-methods pilot study with a purposive sample of patients with pain for more than 6 months. Participants were identified by osteopaths as likely to benefit from pain management support, recruitment interviews explored scope for change and decisions about joining the course were collaborative. 2 patients decided not to join, 2 dropped out through ill-health and 15 completed the course (4 male, 11 female). Participants attended group sessions for 2 h per week for 6 weeks, facilitated by a clinical health psychologist and an osteopath. Data was collected at course start, end, and 3 month follow-up from semi-structured interviews and the Chronic Pain Acceptance (CPAQ), Chronic Pain Values Inventory (CPVI), Bournemouth (BQ) and WHO Quality of Life questionnaires. Results 132 questionnaires were returned (73% response rate). CPAQ scores improved significantly by 3 months for Activity (Z = −2.38, p = 0.02) but not Willingness (Z = −1.68, p = 0.09). Differences between ‘importance’ and ‘success’ in CPVI Relationships scores decreased significantly (Z = −2.12, p = 0.03), indicating increased success living in accordance with family, friends and relationship values, but not in Agency scores for work, health and growth values (Z = −1.75, p = 0.08). BQ scores improved at 6 weeks but returned to previous levels by 3 months (Z = −1.40, p = 0.16) and Quality of Life remained stable. Individual participants with high initial BQ scores reported less fear-avoidance behaviour at 3 months; those with low CPAQ scores showed higher levels of acceptance and activity; but participants with poor scores in both areas showed less overall change. Conclusions Participants showed improvements in motivation and ability to engage in valued activities and personal relationships, but not in pain willingness, fear-avoidance or work activity. The lack of a control group and small, purposive sample mean these results should be interpreted cautiously and interview data is being analysed to explore individual experiences and outcomes. A new clinic is being developed to integrate psycho-educational material into osteopathic treatment sessions, as these results indicate that Mindfulness and Acceptance-based approaches offer promising new directions for enhancing function and agency in chronic pain patients who cannot be ‘fixed’ by manual therapy alone.

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