The difficult balance between evidence-based healthcare … and person-centred self-management

For decades I’ve been an advocate for evidence-based healthcare because the alternative is ’eminence-based healthcare’ (for healthcare, read ‘medicine’ in the original!). Eminence-based healthcare is based on opinion and leverages power based on a hierarchy from within biomedicine (read this for more!). EBHC appealed because in clinical practice I heard the stories of people living with chronic pain who had experienced treatment after treatment of often invasive and typically unhelpful therapies, and EBHC offered a sifting mechanism to filter out the useless from the useful. Where has EBHC led us? Well, we don’t use back belts or rest for low back pain like we did. And we know that movement/exercises can be helpful. And then I get stuck. When we look at exercise, the most widely touted therapy for chronic pain in New Zealand Accident Compensation Corporation pain programmes, we don’t have many clues as to which type of exercise is best for the various forms of pain. We know the effect sizes are dismal for both pain intensity and disability. We know many people just don’t do their exercises without being supervised. And we have no idea just how long people will carry on with exercise once they leave a formalised programme. Worse: we don’t know whether the exercises prescribed during a bout of pain will stand the test of time – because for most people with chronic pain, pain is just that, chronic. It’s ...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Research Science in practice pain management Therapeutic approaches Source Type: blogs