RealHealth offers advice and treatment for back and other pain problems.
The problems we treat come with a variety of diagnostic labels, such as:
For many of these problems (which all cause back and or leg pain) there is no reliable cure. This is the reason that sufferers often explore many treatment options searching for relief, only to find that nothing has really made a difference. We are aware how unhelpful this process can be, causing worsening physical function along with demoralization and hopelessness.
We adopt a best practice approach based on the latest medical evidence.
Many therapists and practitioners offers treatments for musculoskeletal pain that they claim is effective. The best way of knowing whether a treatment works is to undertake properly conducted outcome studies. Recently there has been a move to examine all the outcome studies for a particular approach (say acupuncture or epidural injection) to get a consensus of all the data. This is termed a systematic review.
Systematic reviews of treatments for back pain reveal some surprising results: many of the routine treatments often provided for patients do not seem to make much difference. The treatments that have consistently been shown to work best are active treatment programmes that use a holistic approach (treating mind and body) and using a team of therapists from different clinical specialties. This is the reason that we offer this type of treatment.
Our research has shown that most people coming through one of our treatment programmes can dramatically improve their quality of life, reduce their pain, and improve their confidence and mood even within a 2 week programme.
All of our treatments are tailored to suit the individuals' needs and requirements but all are based on cognitive behavioural (CBT) principles.
Cognitive behavioural therapy is a psychologically based treatment where the emphasis is on helping an individual to understand what is wrong and make positive changes in a systematic, logical and graded way. Rather than telling or teaching, CBT helps the individual at a more fundamental level by helping them to realise that it is thoughts that are important in informing feelings and behaviour. Thoughts are based on information and knowledge but also beliefs and attitudes. Because of this they are not always logical and frequently unhelpful especially when it comes to managing a chronic condition.
CBT treatments have been shown to be effective for a number of different conditions, (including pain and depression) but are not in any way a form of psychoanalysis or psychotherapy. Cognitive behavioural therapy works because it is practical, logical and applicable for a huge number of individuals. Cognitive behavioural therapy uses as its baseline peoples normal behaviour with no implication that they are mentally ill, or in need of psychiatric treatment. It is delivered by psychologists because they are the experts in this field.
What does RealHealth treatment entail?
RealHealth offers a range of programmes delivered in a group format. Usually, there are between eight and ten patients attending a programme. We are convinced that the group format is the best way of providing this type of treatment. It is not a form of group therapy. There is no requirement to disclose personal information in the group, but all the teaching, exercises and other sessions are delivered in a group format. The programmes at RealHealth involves between 50 - 100 hours of patient contact time. Clients benefit from a much greater time with therapists using a group format, which would be prohibitively expensive if delivered on a one to one basis. In addition, patients gain from interacting with others in the group who have had similar experiences and feelings to their own, and can work together on problem solving ideas. Having chronic pain can be a lonely process, the realisation that others think and feel the same as you can be a very important step on the road to recovery.
Treatment is broadly divided into three main areas:
1. Physical reactivation and stretch, with an exercise programme led by a physiotherapist. As suggested above, people with pain often avoid moving and stretching areas that hurt. They frequently adapt by undertaking those movements that they can manage and when exercise is suggested, they focus on these areas. Ultimately, this is counterproductive for the reason set out above. The RealHealth programmes aim to look more analytically at the patient's physical function and encourage them to start stretching painful areas and ultimately move towards engaging in more dynamic exercises with the aim of building up strength and fitness and range of movement. Although, substantial changes are achieved in two - three weeks, the programme is inevitably only the start of the process. Those most successful go on to develop daily stretching exercise programmes, which incorporate mat exercises and their own ideas, which ultimately help to return their physical function to normal.
The difference between a four week programme and a shorter functional restoration programme is the former has a greater psychological emphasis, while the latter is more demanding physically.
2. Activity Pacing, for an individual affected by chronic pain, the simplest solution is to wait until the doctor fixes the problem and then make a return to activity. If this prospect is not forthcoming, they are left with a dilemma of how to make a return to activities even in the face of pain. It is our experience, and that of many other similar units, that individuals can often be helped to do much more than they anticipate by careful analysis of their activity schedule by the development of effective pacing techniques. This may involve an initial use of a timer to take an accurate record of the amount of an activity that can be carried before pain intrudes. By using this level, rather than the time at which pain occurs, a person can more effectively build on their tolerances. In addition, by breaking down tasks into components and by planning carefully activities that have previously been avoided due to a certainty that it will increase pain can once again be tackled. Within this area is a recognition that patients can become habituated to certain activity levels and avoidance of certain tasks, which will not change unless, focused on in an intense graded way. It is also the case that pain provokes a fear reaction and people become fearful of trying something for fear of causing more damage or just worsening their pain. By tackling things in a logical graded way, it is our experience that such fears can nearly always be overcome with the result that activities can once again be engaged in.
3. Psychological approaches encompass everything ranging from education and learning more about pain and its effects, through the development of relaxation techniques and cognitive retraining. We believe that people with chronic illness have to learn as much about their problem as their doctors, and become experts in its management. This involves a significant number of lectures and talks explaining how the pain system works and how it commonly affects people. In particular, it is emphasised that pain does not relate to damage and an understanding of this can help the person to overcome their fears of doing a movement, which might otherwise provoke pain.
With changes to physical performance and the start of seeing some light at the end of the tunnel clients often feel brighter and more positive. However, cognitive therapy focuses on the very human tendency to think negatively in the face of pain and to develop ways of challenging those thinking patterns with a positive benefit to mood and well being. In addition, techniques are offered to aid sleep and reduce medications, which also often have a positive effect on general well-being as well as mood. The result is that individual coping strategies improve which in turn helps to lift depression.