Monthly Archives: January 2020

3 Clinicians Discuss Their Experience With Postgraduate Study In Pain

The more that you read, the more things you will know. The more that you learn, the more places you’ll go.

― Dr. Seuss

Pain is an enormously complex topic.

Even if it was taught adequately in undergraduate allied health education programs, it would be insufficient to master the topic.

But for the majority of clinicians, a thorough undergraduate pain education is not a reality; one only has to see the dissonance that exists on social media currently, and internet forums previously.

This is even more disheartening given how much more is known about pain and how to treat it.

Less than 10% of people with chronic non-cancer pain gain access to effective care, despite the fact that current knowledge would allow 80% to be treated effectively, if there was adequate access to pain services.

Pain Australia

One positive, is that we are seeing an increased interest in post-graduate studies from allied health clinicians.

Ranging from certificates to doctorates, and once the domain of medical professionals, there are increasing options for anyone interested in increasing their expertise on pain management.

With that said, we have a special blog post, where we have interviewed 3 experienced clinicians with post-graduate pain qualifications about their experience with study, and the impact it has had on their careers.

Blaise Doran

First up we have Blaise Doran, a physiotherapist who presented for Beyond Mechanical Pain on Chronic Pain in Paediatric Populations last year, he also wrote a guest post on loaded adaptation.

Quick background: what is your profession, when did you start practicing and where are you practicing now?

I’m a physiotherapist. Qualified and started practice (in- and outpatient, hospital-based) in 2004. Currently working in paediatric persistent pain as part of a multidisciplinary team.

What post graduate qualification did you do? When? Where? Why?

I have 2 post-graduate qualifications:

a) Postgraduate Diploma in Neurological Rehabilitation. Completed 2010/11. Course was via the University of Western Australia (Perth). I did it because I had been wanting to do so for a few years, as I was working predominantly as a neuro physio. I perceived it as a way of keeping up-to-date with the literature, challenging my biases, and future career planning.

b) MSc in Pain Management via Cardiff University in the UK. Completed 2016. Because I was working as a physiotherapist in pain management, and for the same reasons as above. It was also (even as an international student) less expensive than the equivalent course from U. Syd., and there was an opportunity (actually requirement) to do some kind of research project of your own, and write a “mini thesis”. So, really, as CPD on both counts.

How has it changed your practice? For better and/or worse?

GDNR was one of the instrumental influences in me realising that my approach was probably only slightly more effective than a passive intervention. It made me question the foundations of many aspects of physio, not just neuro physio. This, of course, has both positive and negative consequences. Even the strongest evidence has more than its fair share of equivocal literature. It also honed my research lit evaluation skills, and gave me a better understanding of task-specific, “load” aware, repetitive practice as being the most likely way forward for physios in neuro rehab. And that I was likely “under treating” in terms of load and specificity. I changed that.
MSc Pain Management – similar to above, except with persistent pain, and have come away with a much better appreciation of:
• Ethics
• Philosophy (as applied to PT/rehab)
• Contextual effects
• Pharmacology
• Research methods (qualitative and quantitative)
Yes, changed my practice in terms of being open to both translating research findings into practice more quickly and (I hope) effectively, and OTOH, challenging research findings of efficacy that appear not to be effective in the swampy lowlands of clinical practice.
Probably the worst thing is that that I am now an even worse smart-arse than I was before (although I’ve mellowed of late.)

What were the financial implications (initial investment, has it improved your income/business etc)?

Postgrad. Costs.
I mean a lot. Even a commonwealth supported place cost me about 20% of my salary (all up) at the time.
The Masters was a killer, in particular. And although you get some back in tax… erm, it’s not that much.
I got no financial support from my workplaces for either.
Did it improve my earning capacity? No.
There is an expectation in the Victorian PH system that one of the requirements for Grade 3 (and above) “senior” roles, is that you have a post-grad qualification. A post grad qual gives you a risible “allowance” in the Health Professional’s EBA. But ROI, such as it is, is not skewed to the financial gains, IMO.
But, “bang for $” from a professional knowledge and CPD perspective blows away the “weekend course” style CPD.

How did this study affect you as a person?

I realised I had put a lot of effort in to gaining “kudos” for academic achievement, and that I proved (to myself, and many imagined naysayers) that I could. Those demons are sleeping now.

On a scale of 1-10, how likely would you be to recommend this course to other therapists?

Hard to answer, because “formalised” learning and post-grad-post-nominalism is not for everyone, and you can be up-to-date in terms of lit and practice with or without a post-graduate qualification. (But it’s the critiquing and evaluating skills that are good to hone).

1/10 if you don’t get in with Academe.

10/10 if you like doing “mental kettlebell” workouts.

Pamela Dennis

Pamela is an osteopath based in Tasmania, Australia. She runs a practice called North Hobart Osteopathy, with a focus on chronic pain management.

Pamela Dennis

Quick background: what is your profession, when did you start practicing and where are you practicing now?

I started osteopathic practice in 1999 graduating from Victoria University, Melbourne. I started working in a multidisciplinary musculoskeletal practice in Footscray, and with other Osteopaths in Williamstown and Hobart. I also worked in private practice with associates and worked as a Rehabilitation Consultant. Currently I work in team care arrangements with GP referrals and allied health.

What post graduate qualification did you do? When? Where? Why?

I completed a Post Graduate Diploma of Health Science – credit endorsed in Pain and Pain management over four years from 2014-2018 at Otago University, New Zealand, because I’m a dual NZ and Aust citizen and I consider Otago University a leader internationally in Pain Medicine.

The course had developed components on psycho-social and cultural aspects of pain which was extremely interesting to me. Otago colleagues include the course were from all over the world, lectures from Sydney and very interdisciplinary and inclusive in their approach to pain management. The heads of department are world leaders in pain education and this course is recognized by the IASP. Still have contact with lecturers and have enjoyed linking NZ’ers to Australian friends, OA profession etc in this area of professional development. Sharing knowledge is great.

How has it changed your practice? For better and/or worse?

It has fundamentally changed my practice and the way I communicate with my clients. Understanding my culture, changing my beliefs about pain and offering more of the psycho-social model to my osteopathic practice.

I still provide acute care, sports medicine treatments, dry needling, gentler osteopathic techniques (all of them). My hands on practice is “less is more”, and building self-efficacy with graded exposure, pacing, plans to participate is all aspects of patient centered care.

I can realistically set goals as a team with clients who have persistent pain and talk the same language as other health professionals who are part of my clients team care arrangements. More confidence assisting clients and spend more time with these clients listening to them and writing good letters to GP referrers. Which I’m not properly remunerated for.

What were the financial implications (initial investment, has it improved your income/business etc)?

My course fees, time off work and costs were approximately $25,000. It has improved confidence in me by referring Practitioners, like physios, GP’s, psychologists and nurses, etc. who seem to trust me more because I’m talking the same language and my clinical input is valued. My clientele are becoming more self managed and less dependent on manual therapy.

How did this study affect you as a person?

My studies changed and challenged my beliefs, acknowledging my cognitive biases based on some Osteopathic doctrines that was outdated and based purely in belief.

I fully challenged my culture, personal heritage, family and beliefs that formed my understanding of pain and learnt more about types of pain and cultures of pain experience from all over the world.

Studying the history of medical pain models, the history and culture of Pain for thousands of years. I fully understand the theories models and science of pain.

I now understand the difference of neuropathic pain, allodynia, centralization, the DNIC, the brain, the neurotransmitters the pharmacology of pain, the pharmacology and gold standards for migraines, medical surgical procedures for nerve decompression, I understand more about fibromyalgia, gut and brain health, cognitive behavioral approaches, many more non-pharmacological treatments to assist people with chronic pain, especially back pain etc etc.

I feel way more confident in assisting complex patients and help prevent acute patients from falling into the chronic pain cycle with correct language, information and care.

On a scale of 1-10, how likely would you be to recommend this course to other therapists?

I would recommend this course 10/10 to become a contemporary evidence based practitioner in particular with our growing population of complex chronic anxious/depressed elderly obese patients who need the right treatment model.

Claire Richardson

Claire is an osteopath who owns a private practice called Chadstone Region Osteopathy with her husband Shaun (also an osteopath) in Melbourne, Victoria.

Claire Richardson

Quick background: what is your profession, when did you start practicing and where are you practicing now?

I’m an Osteopath. I qualified in 2011 and have treated in private practices around Melbourne since. I have been a practice owner since 2015 with my husband (also an Osteo). I have recently been conferred as an Advanced Pain Management Osteopath through the new Clinical Practice Group initiative from Osteopathy Australia as an acknowledgement of my studies in the field of pain science.

What post grad qualification did you do? When? Where? Why?

I undertook the Professional Certificate in Pain Sciences at the University of South Australia in 2018. I decided upon this course for a few, mainly practical, reasons.

Firstly, it is offered online via correspondence – which was necessary for me as I did not have the opportunity to take time away from work to study. The study hours are flexible and can easily be structured around existing work commitments.

Secondly, it was relevant. This course was not as intensive as a Masters degree and focussed upon the practicalities of applying pain science in a clinical setting. Whilst the content was heavy going at times, it was practical and relevant to the kinds of presentations we see in a private practice setting. By presenting a course which was streamlined in this way, UniSA was able to offer a course which was one year long and significantly more affordable than a more comprehensive post graduate degree such as a Masters.

Thirdly, it was developed and coordinated by the scientists and academics behind Body In Mind, such as Lorimer Moseley and David Butler. I follow BiM closely and their work has inspired me and resonated with me, so I was confident that I would enjoy and engage with their teaching style.

How has it changed your practice? For better and/or worse?

It has informed my practice to be able to offer more thorough and evidence based care for those living with persistent pain. I feel confident that I am able to implement the recommendations from the current understanding of the science of pain. I have always appreciated the need to remain informed and current, but this course has reinforced the importance of staying abreast of the ever evolving science.

What were the financial implications?

Initial investment was $4400 AUD (2 years ago). I have been able to more effectively network with referrers since completing the course, and as a result, see more patients who fit my clinical interests. Having done the certificate hasn’t directly increased my income, however it has meant that I am more professionally satisfied.

How did this study affect you as a person?

This course emphasised the importance of empathy within health care. Whilst I have always believed empathy to be a fundamental skill of the healthcare professional, it has been eye opening to understand just how profound of an effect a therapeutic alliance with a caring practitioner may have on an individual. I believe that I have been able to carry this philosophy into my daily life and interactions with others.

On a scale of 1-10, how likely would you be to recommend this course to other therapists?

For anyone seeking an engaging, clinically relevant, financially manageable and relatively short course, I would highly recommend the Professional Certificate in Pain Sciences from UniSA.


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This post was written by Nick Efthimiou, a contributor to Beyond Mechanical Pain.