094 - Alex Murray Making Sense of Pain Management

Alex Murray is a Canberra based Podiatrist working in private practice and the founder of the website Making Sense in Podiatry. He's passionate about helping other clinicians make sense of evidence and clinical practice with a core philosophy of exploring the complexity of human beings, embracing the uncertainty of clinical practice, and avoiding overly reductionist thinking. He has experience with both national and international athletes and recently transitioned to focusing primarily on helping the general population, and local athletes manage their pain and achieve their goals. On this episode we discuss: The paradigm shift and changing the ways we think about not only our failures but also our successes. Reductionism & Complexity Guided problem solving: why different problems can be managed successfully in many ways Having more treatment options make us better. Pain Management and managing athletes. Patient beliefs and previous experiences will determine their behaviours.  The long-term benefits of understanding and listening to your patient's goals and how to encourage them back into their activity  "Reassurance is a great pain killer." Final Tip Listen: You need to listen before you begin to educate your patient. If you listen, you'll know everything that you need to address. You'll know what the patient's goal is, and you can take that information and apply it to them. With listening, we'll know what they're looking for, expecting, and what makes them fearful. Only then can we can reassure our patients.  Reflective Listening: Reflect what they're saying, so they can either correct us or agree with us. There needs to be a sense of collaboration.  If you have any questions after listening to this episode, please send me an email at [email protected], or you can contact Alex Murray via his website Making Sense in Podiatry, or his Facebook Page.  You'll find a list of  Alex's Reference Articles at the bottom of this page.  Podiatry Business Coaching & Mentoring If you want to own and operate a Thriving Podiatry Business, there are four vital pieces to the business puzzle.   Marketing - You need a well thought out marketing strategy, not just more tactics.  Systems - You need systems that will support your marketing strategy and your team. Team - You need to develop a team culture that makes your work-life balance easier, not harder.  Diary - Your diary needs to be structured in a way that maximises patient numbers and increases daily profits.  You have two choices: There's the slow approach, where you learn by trial and error and do everything yourself, or you can fast-track your education and business success with one-on-one business coaching and mentoring, or group coaching.  If you want to know more, please email me at [email protected], and we can set up a Zoom Call and have a quick chat to see if I can be of assistance.   ALEX'S REFERENCES THE ESSENTIAL PAIN PAPER Moseley, G. L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12(3), 169-178. doi: 10.1179/108331907X223010   Pain papers: Atlas, L. Y., & Wager, T. D. (2012). How expectations shape pain. Neuroscience Letters, 520(2), 140-148. doi: https://doi.org/10.1016/j.neulet.2012.03.039   Hainline, B., Turner, J. A., Caneiro, J. P., Stewart, M., & Lorimer Moseley, G. (2017). Pain in elite athletes—neurophysiological, biomechanical and psychosocial considerations: a narrative review. Br J Sports Med, 51(17), 1259-1264. doi: 10.1136/bjsports-2017-097890   Harvie, D. S., Broecker, M., Smith, R. T., Meulders, A., Madden, V. J., & Moseley, G. L. (2015). Bogus visual feedback alters onset of movement-evoked pain in people with neck pain. Psychol Sci, 26(4), 385-392. doi: 10.1177/0956797614563339   Rio, E., Moseley, L., Purdam, C., Samiric, T., Kidgell, D., Pearce, A. J., . . . Cook, J. (2014). The pain of tendinopathy: physiological or pathophysiological? Sports Med, 44(1), 9-23. doi: 10.1007/s40279-013-0096-z   Testa, M., & Rossettini, G. (2016). Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Man Ther, 24, 65-74. doi: 10.1016/j.math.2016.04.006   Understanding complexity/complex systems theory: Bittencourt, N. F. N., Meeuwisse, W. H., Mendonça, L. D., Nettel-Aguirre, A., Ocarino, J. M., & Fonseca, S. T. (2016). Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept. Br J Sports Med, 50(21), 1309-1314. doi: 10.1136/bjsports-2015-095850   Stern, B. D., Hegedus, E. J., & Lai, Y. C. (2020). Injury prediction as a non-linear system. Phys Ther Sport, 41, 43-48. doi: 10.1016/j.ptsp.2019.10.010   Biopsychosocial model of health Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136. doi: 10.1126/science.847460 Engel, G. L. (1980). The clinical application of the biopsychosocial model. Am J Psychiatry, 137(5), 535-544. doi: 10.1176/ajp.137.5.535     Muscloskeletal Pain/Injury: Caneiro, J. P., Roos, E. M., Barton, C. J., O'Sullivan, K., Kent, P., Lin, I., . . . O'Sullivan, P. (2020). It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med, 54(8), 438-439. doi: 10.1136/bjsports-2018-100488   Lewis, J., & O’Sullivan, P. (2018). Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med, 52(24), 1543-1544. doi: 10.1136/bjsports-2018-099198 Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., . . . O’Sullivan, P. P. B. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med, 54(2), 79-86. doi: 10.1136/bjsports-2018-099878   Shared Decision Making: Hoffmann, T. C., Lewis, J., & Maher, C. G. (2020). Shared decision making should be an integral part of physiotherapy practice. Physiotherapy, 107, 43-49. doi: https://doi.org/10.1016/j.physio.2019.08.012   Clinical Decision Making: Simpkin, A. L., & Schwartzstein, R. M. (2016). Tolerating Uncertainty - The Next Medical Revolution? N Engl J Med, 375(18), 1713-1715. doi: 10.1056/NEJMp1606402   Walton, D. M. (2019). The critical skill of asking why? An endorsement of critical reflection in physiotherapy research and practice. Musculoskelet Sci Pract, 41, iv-v. doi: 10.1016/j.msksp.2019.04.005   Zou, K., Wong, J., Abdullah, N., Chen, X., Smith, T., Doherty, M., & Zhang, W. (2016). Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis, 75(11), 1964-1970. doi: 10.1136/annrheumdis-2015-208387   Communication:   Soklaridis, S., Hunter, J. J., & Ravitz, P. (2014). Twelve tips for asking and responding to difficult questions during a challenging clinical encounter. Med Teach, 36(9), 769-774. doi: 10.3109/0142159x.2014.916782   Zolnierek, K. B. H., & Dimatteo, M. R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical care, 47(8), 826-834. doi: 10.1097/MLR.0b013e31819a5acc