Bridging a painful gap

Abstract

The therapist seeks to manage patients' problems by progressing along two pathways which do not necessarily run in parallel: painful to painless and functionless to ‘functionful’. This means joining the pathway at one of an infinite number of points, which may be determined by well reasoned assessment. This presupposes the availability of reliable and valid examination procedures which, when applied, will lead to appropriate evaluated therapeutic techniques. In practice this is rarely the case, clinical decision-making processes being tempered perhaps too often with past experience and patient mileage analyses which, as Sim (1995) points out, may often be of value but may also perpetuate our own biases and misconceptions.