Chronic Pain: A resource for effective manual therapy

by Philip Austin

Overview

The effective management of pain is a problem which confronts all manual therapists. This book provides a clear picture of our current understanding of pain mechanisms and shows how that knowledge should inform approaches to treatment. The knowledge of pain science that the book conveys will help the therapist select the best approach to the clinical management of each patient. Different types of pain disorder may require different management strategies which may involve only one discipline or, at other times, a multidisciplinary team which may also include medical clinicians, psychologists, occupational therapists, nurses and other healthcare practitioners as well as manual therapists. The book is divided into three parts:


An introduction to the concept of pain and its neurophysiological mechanisms.


A review and discussion of current and potential evidence-based evaluation methods.


A review and discussion of common types of functional pain disorders.


This approach provides readers with a comprehensive reference to evidence-based information that should enable them to manage their clients' pain as effectively as possible.

Product Details

ISBN-13:	9781909141513
Publisher:	Jessica Kingsley Publishers
Publication date:	10/05/2017
Pages:	256
Product dimensions:	7.40(w) x 9.61(h) x 0.63(d)

About the Author

Phil Austin is a UK-trained osteopath and researcher who holds a PhD in pain medicine. Phil's clinical areas of interest include the treatment of computer-related musculoskeletal pain conditions and the effects of work-related stress on the severity and duration of persistent pain.


Phil graduated from the European School of Osteopathy in 1997. Following the completion of his degree Phil worked in New Zealand, UK and Sweden and is now permanently located in Sydney where he combines his clinical work with research. This includes the investigation of clinical methods of predicting the extent and severity of pain in people with chronic pain conditions such as fibromyalgia and in cancer patients receiving chemotherapy. He is also a member of the Australian Osteopathic Accreditation Council and a leader in the Chronic Pain Practice Group


Phil began his postgraduate studies at the University of Edinburgh gaining an MSc in pain management and a PhD investigating the potential for multi-dimensional assessment of functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia. Phil works as a clinical tutor for the MSc in Clinical Management of Pain at the University of Edinburgh while also being involved in various areas of palliative care research at Greenwich Hospital in Sydney.

Editorial Reviews

Reviewer: Mary M Tuchscherer, MSc, DC, PhD (Northwestern Health Sciences University)
Description: Chronic pain is a significant problem facing society, and a common concern for all manual therapy practitioners. This book focuses on three major components related to chronic pain: the mechanisms associated with the generation and progression of chronic pain; its epidemiology, diagnosis, and treatment; and, finally, recognition of its various presentations.
Purpose: The purpose is to provide students and practitioners of manual therapies, as well as the well-informed public, with a single book dedicated to reviewing the best available evidence associated with nervous system mechanisms of chronic pain generation, recognition of the condition, and the various manual treatment modalities that can be used to manage chronic pain. The author reviews the literature and offers well-reasoned recommendations for manual therapies (spinal manipulation, stretching and exercise, massage, and others) based on the various types of chronic pain (musculoskeletal, orofacial, headache, and visceral). A prominent feature of this book, often given a more minor role in other books, is the contribution that emotional, psychological, and spiritual well-being play in the progression or resolution of the chronic pain syndrome. These are very worthy objectives, given the opiate addiction crisis. As mentioned in the book, the direct and associated costs of chronic pain outweigh those for heart disease, cancer, and diabetes. Manual therapy is often overlooked as a last resort treatment option, when, in fact, it should be the frontline therapy. The author supports this view by reviewing the clinical trial literature and offering well-reasoned recommendations for the various chronic pain conditions. He also makes very good arguments for research areas and topics that need to be addressed. This is certainly of interest for students of the discipline.
Audience: Although written for a broad audience, readers with a background in basic neuroscience will most appreciate the detail and specificity, especially as it is presented in the first section on the neuropharmacological and molecular mechanisms of chronic pain. Students of osteopathy, chiropractic, and physical therapy will benefit, as will medical students. Medical doctors in orthopedic, neurology, and other musculoskeletal pain specialties will benefit from the well-written and well-supported literature review demonstrating the significant benefits and minimal risks of manual therapies. A very useful feature of the book is that the basic science mechanisms are discussed in light of what is known about how manual therapies impact chronic pain treatment. All practitioners will benefit from the discussion of the psychological components of chronic pain and the positive associated treatment modalities. The author has worked as both an osteopath and as a researcher, with a special interest in biopsychosocial assessment and behavioral aspects of chronic pain.
Features: The initial section on peripheral, spinal, and central neurological mechanisms of chronic pain is very well done. While many other reviews of this material have been published, few give such a clear description of how the manual therapies are supported by the basic science evidence. The molecular and neuropharmacological concepts can be very confusing, for example the differences between peripheral and spinal sensitization, but the author does a very fine job of making these concepts both accessible and useful. It is particularly illuminating to recognize that the relatively few pharmaceutical options available to treat chronic pain may be due to the fact that the biology is very complex. As the author points out, since manual therapy practitioners work with the body's own biology, the low potential for adverse effects is very attractive. Recognition of chronic pain as "not just a prolonged episode of acute pain" is very important to all practitioners. Too often, patients languish in long treatment plans that have little basis in impacting the mechanisms that result in chronic pain. The more assertive, creative, and individualized plans combining patient participation in positive behavioral change is very refreshing. It has long been known that patient preference for the manual therapies results in better compliance and fewer adverse outcomes. The final part of the book distinguishes the various types of chronic pain. It may come as surprise to some that there is more than one type of chronic pain. Understanding these concepts will most certainly result in better and more specific treatments, as well as better research methodologies and study designs. One thing that is very confusing to students and practitioners alike is the alphabet soup of acronyms used by neuroscience researchers. The glossary at the beginning of the book is very useful in keeping readers from becoming hopelessly lost in acronyms. The tables and figures are well done, summarizing often complex concepts that are discussed in more detail in the text. One area of disappointment is that while researchers at very fine chiropractic colleges have provided a great deal of the literature, including several randomized controlled clinical trials supporting manual therapies for musculoskeletal conditions (which very often result in chronic pain), the words "chiropractic" and "spinal manipulative therapy" are not included in the index. The citations are mentioned in the book and listed as references, but readers cannot easily find that information by looking at the index. To be fair, "osteopathy" is not in the index, either.
Assessment: This is a useful and well-written book. There are other books that review each of the aspects of chronic pain separately (basic science mechanisms, diagnosis principles, treatment options, and the importance of the whole person, mind and body), but to my knowledge, none does such a thorough job of all the above. Students and practitioners will likely find new information and renewed curiosity for the topic in this book. Many readers will be familiar with Bonica's Management of Pain, 4th edition, Fishman et al. (Lippincott Williams & Wilkins, 2010). It is certainly exhaustive, given its nearly 1,700 pages, and rather inaccessible, given its $360.00 price tag. For those seeking a more clinically friendly book, this one may well be the book for you.

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