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Exploring the Pain and Movement Reasoning Model

Emma Breheny
29 July 2016


Lester Jones, APAM, will be presenting on the Pain and Movement Reasoning Model at this year’s NSW Bringalong Dinner, a chance for healthcare professionals from all disciplines to learn and network in a social setting.

The Pain and Movement Reasoning Model, developed by Lester in conjunction with Des O’Shaugnessy, APAM, arose out of a difficulty to work with the established biomechanical models of physiotherapy when treating the complexities of pain. Advances in the understanding of neurobiology and neuroimmune endocrinology led to an acceptance among many physiotherapists that each pain presentation must be considered within a host of factors.

The model was born a decade ago but first gained prominence with a Manual Therapy article in 2014. Two years on, Lester is seeing the model’s application in situations as diverse as breastfeeding-associated pain and pelvic pain in women. He’s now undertaking a PhD through the Judith Lumley Centre, La Trobe University, to identify how clinicians are adapting the model to their own practice and what outcomes they’re seeing.

You’ve mentioned the model can be adapted to individual clinical practice. How can people start to imagine this fitting into their day-to-day work?
The model consists of three categories focusing on the main mechanisms that we think influence and determine pain. We’ve found this allows people to create sub-categories to suit a specific context. In essence, they can create a bespoke model to match their knowledge and skills, as well as the patient groups that they’re seeing. Physiotherapy is a very personal practice; you probably won’t find two physiotherapists who do exactly the same thing due to various influences. It’s important to recognise this when we’re trying to help people negotiate the complexity of pain.

Why do you think the model has this broader applicability?
One of the main things we aimed to do with the model was create something that was very mechanisms-based, but also flexible and adaptable to the person’s pain experience. We often see patients’ pain can change quite a lot over the course of treatment, or even a session. We wanted to be able to capture a dynamic process of reasoning.

What other applications are you seeing?
Apart from its use in breastfeeding and pelvic pain, I’ve also presented the model to multidisciplinary groups made up of GPs, nurses, psychologists and counsellors who work with survivors of torture. This again reflects more complicated presentations of pain where people have obviously been through trauma as well.

What will your presentation be focusing on?
Neuro-immunology and epigenetics are suggesting that people’s life experience prior to an injury has quite an impact on their pain presentation. As clinicians, we need to reflect on that when we’re assessing someone’s presentation. For a long time, I’ve tried to avoid using terms like acute pain and chronic pain because I think that can lead to an unsophisticated approach to reasoning around pain.

I’ll use my presentation to encourage people to start with the three core categories of the model, and go away to unpack some of the things that might influence their personal reasoning. I think, increasingly, people have got a greater awareness of how complex pain can be. Hopefully the model will provide some simple strategies to start to unpack some of that complexity.

The NSW Bringalong Dinner is happening on 14 October. Registrations are now open.

 

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  Lester Jones, APAM, will be presenting on the Pain and Movement Reasoning Model at this year’s Bringalong Dinner, a chance for healthcare professionals from all disciplines to learn and network in a social setting.
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  Lester Jones, APAM, provides an overview of his recent presentation at the NSW Bringalong Dinner, ‘Introducing the Pain and Movement Reasoning Model: a tool for capturing the complexity of pain’.
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