Body-mindfulness in physiotherapy for the management of long-term chronic pain

Abstract

Western health professions are trying to become more effective in helping patients to manage chronic pain and, as a result, are looking to complementary and alternative methods, often originating from the east (Asia). The physiotherapy profession, however, appears to be at a critical juncture in its development, whereby incorporation of too much holistic treatment may destabilise 'the body as a machine' concept, a concept that has long been the profession's major basis for its rationale for treatment. Yet, a large amount of recent literature has warranted the need for physiotherapists dealing with chronic pain, to understand the psyche as unseparate from the soma in order for treatment to provide a lasting effect. Such understanding puts large emphasis on physiotherapeutic intervention being placebo- or nocebo-based, thus implying that intervention will often become a necessity in order to tolerate pain, or, become a conduit that exacerbates the pain. This is supported by evidence indicating that both modality intervention and psychological intervention are one of the key inhibitors to those with long-term chronic pain effectively managing their condition independently. Body-mindfulness practice, stemming from an ancient Indian form of meditation, is a process adopted recently by behavioural therapists in the West to ease psychological disorders. It claims to bridge the intervention conundrum in those suffering with long-term chronic pain. Body-mindfulness practice might, therefore, prove useful as a self-empowerment process in addition to being an antidote to dependence or exacerbation from physiotherapy treatment intervention. The physiotherapy profession has been looking for ways to merge the conceptual understanding of the 'body as a machine' with holism and is keen to do this without sacrificing its highly regarded professional status. Body-mindfulness practice appears to be a middle road that blends unreactive awareness to the grounded reality of arising physical sensations, healing the Cartesian split of the psyche from the soma. In addition, physiotherapists appear to be well suited professionals for guiding body-mindfulness practice due to their ability in assessing the fundamental aspects required for the process to unfold.