The role of a therapist as treating in solely a ‘manual’ or ‘biomedical’ way is becoming a thing of the past. More and more we are recognising the importance of treating the ‘psycho’ and the ‘social’ components intrinsically involved in a pain experience. But is it actually happening?

A new qualitative study in 2017 from Italian physiotherapists seems to think not. This study adds to the many others (here and here among others) that are highlighting a gap: therapists acknowledge the importance of ‘biopsychocial’ factors, they even identify them, but rarely treat them. Why? Time constraints? Laziness? Perhaps more likely they don’t know what to do with these factors. I’ve often heard people saying – ‘I’m not a psychologist or a social worker, I don’t have the training’.

The 2017 paper seems to agree. The authors have provided a summary of their insights in a blog over at Body in Mind – worth a read! Some of the barriers they bring up include:

• a general view that the role of physiotherapists was mainly as a manual therapist performing physical treatments
• limited opportunity during their sessions to fully assess psycho-social factors
• concerns that exploration of psycho-social factors could lead to a disruption in the therapeutic relationship (i.e. fear of “losing the patient”).
• uncertainty about how to implement psycho-social aspects in a specific and meaningful way.

Here at NOI we’ve attempted to make this last point easier with educational texts for therapists (Explain Pain, Explain Pain Supercharged and courses) and guided texts for patients (The Explain Pain Handbook: Protectometer). The DIM/SIM approach to pain specifically includes an exploration of these psycho-social factors in an approachable and accessible way (check the App).

What do you think is missing? Is it a cultural change within the profession? A societal change from what patients expect from their therapists? Improved training at an undergraduate level?

– Hayley Leake