A new paradigm for musculoskeletal pain care: moving beyond structural impairments. Conclusion of a chiropractic and manual therapies thematic series

Abstract

This commentary closes the thematic series “A new paradigm for musculoskeletal pain care: moving beyond structural impairments”. The papers published in the series point to key aspects of shifting the paradigm of musculoskeletal care from clinician-led management often focused on addressing presumed structural anomalies to partnering with patients to find individual strategies that empower patients towards self-management. Several papers in the series highlighted the need for developing patient-centred models of care that respect individual patient’s needs and preferences. Also, the series pointed to different options for modes of delivery including mHealth and the challenges and opportunities they present for developing person-centred strategies. For health care to provide effective support for people with musculoskeletal pain conditions, there is a need to recognise that contextual factors, including a strong patient-provider alliance, clearly play an important, perhaps primary, role. Health care professions dealing with musculoskeletal pain conditions should engage in research to investigate effective ways to move this understanding into practice including how to train providers. We hope the work collected in this series will stimulate further questions and more research as musculoskeletal pain providers seek to make their care more person-centred.

The effect of self‐management techniques on relevant outcomes in chronic low back pain: A systematic review and meta‐analysis

“…Furthermore, the effect for pain catastrophizing was not as large as we expected, even though the absolute point estimate for the effect was also larger than for pain intensity. Digital self-management interventions are expected to reduce pain-related thoughts in patients and manage feelings of helplessness if they are in pain (Fritz & Kongsted, 2023). Also, recent evidence suggests that pain catastrophizing is a key outcome in patients with back pain and that it is worth investigating treatment programs that are specifically tailored to reduce catastrophizing (Darnall et al, 2020).…”

Functional Neuromyofascial Activity: Interprofessional Assessment to Inform Person-Centered Participative Care—An Osteopathic Perspective

“…According to person-centered care principles for musculoskeletal pain, there is a need to improve the therapeutic alliance and to establish meaningful connections with the patient/participant by using the body, and related movement, as a pivot point [4]. Manual therapies can be useful as part of overall management to support a patient's specific daily activities: physiotherapy [6], chiropractic [7], and osteopathy [8]; providing a combination of manipulative strategies and assisted exercise can supply the movement challenges necessary for optimal recovery [9]. The patient recovery process can be optimized by co-creating based on individual patient environments and considering self-care as a dominant component in process management.…”