Individualising explanations with case formulation

One of the assumptions of a multidimensional model of pain, particularly chronic pain, is that somehow all the various elements get pulled together to explain why this person is presenting in this way at this time. It’s also one of the least-discussed aspects of pain management: case formulation. Case formulation is the process of generating a set of hypotheses to explain what is going on when a person has chronic pain. It needs to reflect what is known about biological mechanisms, including comorbidities; psychological aspects such as beliefs, attitudes, expectations, pre-existing strengths and capabilities; and social and contextual aspects such as supportive relationships, availability of health services, employment and so on. It should help explain how facets of the situation have arisen, and what is maintaining them.  It should guide intervention, and identify treatment targets, and most importantly, it should help the person feel he or she is being heard and help them understand why certain approaches are taken. What often happens, however, is that a person with pain is assessed comprehensively – and the findings are filed away, or used only as “baseline recordings”, treatment carries on using “I have a hammer, all I’ll use are nails”, and the particular concerns of the person remain untouched.  Alternatively, the assessments are discussed by the team (if there is one) and the most socially capable or dominant person holds swa...
Source: HealthSkills Weblog - Category: Occupational Therapists Authors: Tags: Chronic pain Clinical reasoning Pain conditions Professional topics Assessment biopsychosocial function healthcare rehabilitation Therapeutic approaches treatment Source Type: blogs