My Proposed explanation for an ineffectual system
If the fact that pain from musculoskeletal sources continues to be, basically, the most burdensome chronic condition faced by developed countries (Ref) has irked you as much as it has me, then you won’t mind this aside from the regular playbook. The ‘State of the Union’ address is coming up, I promise you. My first post, on the pathologising of pain, caused some confusion with some so this might help clear that up.
So why is the pathologising of pain a bad thing? Because it leads to a massive burden; yet another that our generation now has to live with. I have developed a model on how, I believe, the pathologising of pain has directly attributed to a global burden and potential solutions to this. It is useful to think of pain, not as you may know it, but as a third variable – a ‘meme’ if you will. A social gene that propagates throughout society depending on its utility.
In my opinion the current healthcare system’s over-diagnosis, over-investigation and over-treatment has lead entire populations into a state of dysfunctional pain beliefs and has lead to reward systems reinforcing these. Our society is now, effectively, in a ‘hyper-pain’ state, where pain is not transiently troublesome as it may have been in the 1920s. It is permanent, it permeates society, it is monetised and it has an entire industry devoted to it. Maybe the best thing for society is to keep moving, get less obese, get less sedentary and – low and behold – to be left alone and let natural history do what it does best.. resolve issues. Only intervening significantly in the truly pathological cases might be a start. This goes hand in hand with the message from most of the mainstream physiotherapy media for the last 5 years; simple advice is the cornerstone of all treatment. This gives the power back into the patient’s hands and reduces any risk of destructive pain beliefs. And as always I’m keeping this discussion localised to my profession, as I am only qualified to do so, but I wonder what would happen if surgeons had more stringent regulations on operating for pain in all areas of the body?
In my ‘ideal world’ pain is incorporated into public health campaigns, so EVERYONE knows the value of truly pathological pain and the mechanisms through which these come about. Our red flag, spinal cord compression, cauda equina and radiculopathy screening questionnaires should be in the hands of everyone to utilise. Everyone should have the awareness of the natural history of low back pain. A push toward normalising the ‘minor’ types of pain and injuries, so these do not become larger issues, should be implemented. Lastly, and the toughest one, is building a system around regulating the over-treatment (with passive modalities) that is rife amongst some industry sectors. Health insurance companies already cap the amount of rebates you will receive, but maybe tougher regulation of this has to exist? Possibly health insurance companies should go further to reward you for less visits to the ch(.. almost said it…) – ah nearest practitioner – similar to the way they reward healthy lifestyle behaviours. This is in the ‘private’ sector; the public sector may have to rely more on educational strategies starting at basic, primary-age, levels.