10 minute read
Self-management of chronic back pain
ESCAPE-pain is an evidencebased and cost-effective group rehabilitation programme for people with chronic joint pain – specifically people living with chronic back pain and those with chronic knee and hip pain.
Advertisement
Designed to increase physical function and improve quality of life, the concept integrates education, self-management and coping strategies, with a personalised exercise regimen for each participant.
Two new e-learning resources have been developed by Health Education England’s e-Learning for Healthcare and its partners to help practitioners understand the principles behind the programme and how it may be implemented in their organisation.
Variety of locations
The ESCAPE-pain programme can be delivered in a variety of locations including outpatient physiotherapy departments, leisure centres and local community settings by healthcare professionals and exercise instructors.
To deliver to either of the ESCAPE-pain groups, professionals are required to attend facilitator training. The training is open to healthcare professionals and exercise instructors who meet the prequalification criteria.
Each e-learning session takes approximately 20-30 minutes to complete, with the aim of improving providers’ understanding of what the programme involves and to prepare for the facilitator training.
The research, evidence and endorsements for each programme can be found on the ESCAPE-pain website.
The programme will not cure nor eliminate pain completely. However, it aims to reduce
pain, improve physical function, self-confidence, sense of being in control of problems, and the depression and frustration that is often felt with chronic pain.
ESCAPE-pain for backs is delivered as two classes a week for six weeks (12 classes in total). Class size is usually about 8-10 people. Each class
Sessions can be delivered by healthcare professionals and exercise instructors
COMMONLY used treatments for chronic pain can do more harm than good and should not be used, National Institute for Health and Care Excellence (NICE) has said in recent draft guidance.
Paracetamol, non-steroidal antiinflammatory drugs (these include aspirin and ibuprofen), benzodiazepines or opioids should not be offered for people with a type of chronic pain called chronic primary pain. This is because, while there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress, there was evidence that they can cause harm, including possible addiction.
Instead, the draft guideline says that people with this type of pain should be offered supervised group exercise programmes, some types of psychological therapy, and says that some antidepressants can be considered.
Chronic primary pain represents chronic pain as a condition in itself and which can’t be accounted for by another diagnosis, or where it is not the symptom of an underlying condition (this is known as chronic secondary pain). It is characterised by significant emotional distress and functional disability. Examples include chronic widespread pain and chronic musculoskeletal pain, as well as conditions such as chronic pelvic pain.
The draft guideline also says that antiepileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary pain. Again, this was because there was little or no evidence that these treatments work but could have possible harmful effects.
The draft guideline emphasises the importance of putting the patient at the centre of their care, and of fostering a collaborative, supportive relationship between patient and healthcare professional.
usually starts with a brief (15- 20 minute) group discussion around a specific topic relating to back pain. This gives you the opportunity to share your experiences with other participants and discuss the session topic further.
This is followed by around 40- 45 minutes of a simple circuittype exercise programme. A physiotherapist or an exercise professional will supervise the circuit and tailor exercises to suit your needs.
If you would like to know more about the programme, including access details to the e-learning sessions, please email the team at: hello@ escape-pain.org for more information.
Image: rawpixel.com/Freepik
A chance to talk about your experiences with others
Setting yourself a goal
YOUR facilitator will explain that it is easier to become more active and do more exercise if you set yourself a goal.
You can start by thinking about something that you really want to do, for example, going to the park with the grandchildren or working in the garden for 30 minutes a day. You can then put together an action plan, explaining: l what you want to achieve (your goal, for example, working in the garden daily) l when you will achieve it (e.g. three months) l how you will achieve it (e.g. completing ESCAPE-pain and continue to exercise twice a week after that) l where you will achieve it (e.g. exercising at home and at the local gym)
Your facilitator can help you in setting some short-term goals as stepping-stones to achieve your main goal. https://escape-pain.org/
It also highlights good communication and its impact on the experience of care for people with chronic pain.
Acupuncture is recommended as an option for some people with chronic primary pain, provided it is delivered within certain, clearly defined parameters.
Nick Kosky, a consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust and chair of the guideline committee said: “Understandably, people with chronic pain expect a clear diagnosis and effective treatment. But its complexity and the fact GPs and specialists alike find chronic pain very challenging to manage, means this is often not possible. This mismatch between patient expectations and treatment outcomes can affect the relationship between healthcare professionals and patients, a possible consequence of which is the prescribing of ineffective but harmful drugs.
“This guideline, by fostering a clearer understanding of the evidence for the effectiveness of chronic pain treatments, will help improve the confidence of healthcare professionals in their conversations with patients. In doing so it will help them better manage both their own and their patient’s expectations.” www.nice.org.uk
Making the transition out of lockdown –in the office and at home
As the coronavirus pandemic starts to ease, businesses and employees face major challenges in transitioning back to life in the office and, increasingly, the “blended working” approach of part-time office/parttime at home.
FOR office-based employees, this may mean no more hotdesking and getting used to working back to back (not face to face). For home workers, it will be vital to avoid awkward makeshift workstations that can lead to severe back and neck pain.
NICHOLA ADAMS, a leading ergonomist and founder of the consultancy Inspired Ergonomics, has conducted hundreds of assessments remotely during lockdown and has noted how cautious many employers are about the health and welfare of their workforce in the office, especially as a second wave of the virus remains a risk.
She commented: “With many of us facing up to another six months at home, there’s now a lot of confusion about what people should be doing, especially as there are still so many unknowns ahead.
“Homeworkers are struggling. One lady in her 20s, who works for a London law firm, was using her ironing board as a laptop desk and a rickety fold-up garden chair to sit on. The ironing board was too high, giving her severe neck and shoulder problems. The garden chair had a gap at the back, so without support, she got lowerback pain – all compounded by her moving less than she normally would in the office.
“Others use dining tables that are too high, or their beds, slouching and craning their necks. One lady used her sofa arm as a mouse mat. People think they know how to set up a workstation correctly, but they need professional support and advice.”
To help ensure a safe workplace – whether in the office or at home – Nichola Adams offers employers and employees her ten transition tips on how to ease out of lockdown:
FOR EMPLOYERS 1 CONSIDER DITCHING
‘HOT-DESKING’ It’s going to be essential when we return to the office to implement a new “singledesk-per-day” regime and to clean work surfaces like desks, chairs, monitors, keyboards and mice, at the end of every individual worker’s shift. So, this does sound a death knell for the widespread cost-saving practice of “hot-desking”. For longer-term homeworking, use tables and office chairs
2 DOWNSIZE TO LOWER
CAPACITY Because of the continuing rules on social distancing, companies with, say, 100 staff, will now only have capacity for 20-40 employees in the office at any one time. The need to radically reduce the amount of people in the office has already prompted many companies to rotate staff by day or by the week, to widen the spread between teams.
3 GET BUSY SCREENING
AND CLEANING Screens or barriers may be needed around desks. Pods or self-contained units for workers will have partitions on all sides of the desk to stop the virus spreading when we cough and breathe. Workstations should be cleansed after every shift, also chairs, tables, monitors and office break-out furniture as the virus lands on many surfaces. If used, reception sofas should be cleaned after each arriving guest.
Beware ‘makeshift’ set-ups at home
4 INCREASE SUPPORT FOR
YOUR WORKFORCE A new Institute for Employment Studies (IES) survey of 500 homeworkers found 75% said their employer had not carried out a health and safety risk assessment of their homeworking arrangements in lockdown. People are confused, need help, guidance and want to feel safe. I recommend employers host health and wellbeing workshops, support employees’ mental health, and conduct fresh office ergonomic Positioning equipment incorrectly can cause shoulder and neck strains, headaches and migraines
workstation assessments, which they’re legally obliged to if workstations move. Some staff may feel keen to return to the office, others nervous. Talk to individuals about their concerns.
5 DOUBLE EMPLOYEE
ALLOWANCES Musculoskeletal issues like back pain and injuries, and neck and upper-limb problems, cost UK plc nearly seven million women who haven’t been used to carrying them in lockdown.
working days a year. Part of the problem of homeworking is few people have the right equipment to work comfortably in the long term. In lockdown, some companies are offering homeworkers an allowance (average budget from £150) to buy work furniture. But with rough costs (chair £100-£150), (table £60-£90), (keyboard £40), (mouse £20) adding up to £300, employers should double their allowance. Also, offer advice on what equipment to buy, or consider sending their office equipment home.
FOR EMPLOYEES
1 BEWARE ‘MAKESHIFT’
SET-UPS AT HOME The IES survey found, on average, a 50% increase in back pain issues in lockdown. It’s crucial to seek advice on how to create your homeworking set-up correctly. I’ve seen makeshift workstations using ironing boards, drinks cabinets, coffee tables, bar stools, sofa fresh ergonomic workstation
armrests and old fold-up garden chairs and tables. Around 5% of people are slouching on beds. You can get away with it short-term but for longer-term homeworking, use tables and office chairs. Positioning equipment incorrectly can cause shoulder and neck strains, headaches and migraines.
2 THINK TOILET SEAT! Research on germs by blood circulation, ease muscle
UK ergonomics firm BakkerElkhuizen shows there are 45,670 more bacteria on an average computer mouse than there are on the average toilet seat; 20,598 more on a keyboard than on a loo seat. Returning to your office, take your keyboard and mouse with you so any germs are your own. Leaving work, wipe clean to avoid taking office germs home.
3 SWAP HANDBAGS FOR
BACKPACKS neck and shoulder injuries to Out-of-condition muscles make it especially important to distribute the weight of your belongings evenly using a backpack, preferably with adjustable, padded straps. As many of us may be avoiding public transport, backpacks are also ideal when cycling or walking to work.
4 WATCH YOUR BACK Government guidelines recommend that office workers should no longer be sitting face-to-face at their desks. Instead, employees social distancing correctly are being encouraged to sit back-toback or side-by-side, and six feet apart. This may mean desks moving position, so a assessment is recommended.
5 MAKE A STAND With companies reducing their capacity and allowing fewer employees in the office at any one time, work rooms will be less full. Provided you follow social-distancing guidelines, this new environment allows you to stand up and walk around more often, along the guided route. Take regular screen breaks, stand up and move about to help improve Heavy handbags can cause
tension build-up and prevent injury. Do this at home, too.
www.inspiredergonomics.com
