“the treatment and management of LBP have come a long way since the mid-70′s. It seems that the case no longer needs to be made for looking at LBP in its context.” @JanHartvigsen @aaron_kubal @MattLowPT @Peter_Stilwell https://link.springer.com/article/10.1007/s10926-020-09913-y

2) “I have struggled with a number of questions over the years, which can serve as a road-map of the “drivers” underpinning the LBP story.”

3) “Why do People with “Apparently” the Same Physical Findings Differ in how Disabled They Become?”

4) “In truth, the original 1984 biopsychosocial model might more properly be termed a “biopsychological model” since we had not yet been able to clarify the social part of the model”

5) “the major LBP-related event of the decade - 1990s - was the publication of GW’s The Back Pain Revolution, which not only established LBP as a BPS phenomenon, but recommended a change in the routine management of uncomplicated LBP from rest & opioids to re-activation.

6) “Psychologically Informed Practice (PiP)...placed LBP management in a person-centred framework. Our main intention was to distinguish PiP both from traditional biomedical care & from care of more serious mental illness.”

7) “PiP relies heavily on the cognitive-behavioral approach to pain management, although with an increasing emphasis on experiential learning and communication skills.” @PeteOSullivanPT @jpcaneiro @JeremyLewisPT

8) “while it is possible to declare some guiding principles and ways of doing business, context is all-important not only in the management of disability but in the assessment of pain & its impact.”

9) “PiP is based on a normal psychology of people’s beliefs, expectations, emotional responses and coping strategies.”

10) “A word of caution, however. PiP is not a magic solution. It is essentially a synthesis and refocusing of previous work (primarily in the field of pain management), although innovative perhaps in the extent of its focus on communication.” I love the emphasis on communication!

11) “most non-specific LBP will resolve or become troublesome only intermittently without treatment. We are over-treating patients and must take some responsibility as healthcare professionals for the chronic pain crisis.” @MaryOKeeffe007 @CGMMaher @jeubanksMD

12) “there has been a plea for fundamental change globally in LBP management, at a system & health policy level, in healthcare delivery w/ the implementation of cost-effective strategies..

13) “... that provide access to effective care ensure early ID & adequate education of patients w/ LBP at risk for persistence of pain & disability.” @WorldofHurt2

14) “This will require not only tackling vested interests in retaining the status quo, but training of healthcare professionals in facilitating effective behaviour change.” @OsteloR

15) “the treatment and management of LBP have come a long way since the mid-70′s. It seems that the case no longer needs to be made for looking at LBP in its context.”

16) “Pain does not occur in a vacuum, but in a social context in which interpersonal interactions and communication may affect an individual’s pain experience.” https://www.degruyter.com/view/journals/sjpain/ahead-of-print/article-10.1515-sjpain-2019-0180/article-10.1515-sjpain-2019-0180.xml?language=en Main & Linton 2 legends.

17) “because communication is one of the most powerful components of pain treatment, gaining a better understanding of interpersonal communication in the context of pain is timely and important.”

18) “ The social systems
Expanding to an even broader context, one might also say that pain is, in some respects, a system-level problem requiring system-level solutions.” @_Tyson_Beach

19) “It is thus neither possible nor desirable to focus on either the individual, the organization or the community. They all coexist and mutually influence each other, and this needs to be taken into account when designing and implementing interventions.” @chadcookpt

20) “psychosocial influences on pain outcomes may be a product of many circumstances, and individual factors may not be so individual after all...health care providers may hold beliefs reflecting fear-avoidance that can influence patient beliefs and behavior” #nocebo

21) “health care providers may hold beliefs reflecting fear-avoidance that can influence patient beliefs and behavior”

22) “A recurring complaint of patients with chronic pain is that their pain and associated suffering are not recognized by their treatment providers...

23) .. it is hoped this new framework will facilitate acceptance of a patient’s experience of pain as real, regardless of physical findings. Accepting a patient’s pain as real through validating communication is known to decrease emotional distress in pain sufferers”

24) “Future directions
factors such as social capital, resilience and emotional dysregulation, and contextual influences on social communication models merit further investigation”

25) “the most immediate priorities appraise the process of intervention and the nature of communication” This is gold!! Our template or process must pivot to listening & helping people make sense of their story. @PeteOSullivanPT @PainRevolution

26) “This requires the identification of the determinants of the behavior change we are targeting, while helping our clients/patients implement and sustain the behavior change both during and after our contact with them” A resilence not reactive mindset.

27) “structured communication models...can serve as a useful scaffolding for the clinician when performing pain management (PM) and thus become central in secondary prevention (SP).”

28) “The other side of the coin: resilience as a pathway for improving treatment results ...The identified prognostic factors confirm the importance of the main tenets of the fear-avoidance model of chronic pain but additionally point to a role for resilience factors.

29) “the latest version of the fear-avoidance model incorporates positive affect and optimism as factors that may counteract inflexible engagement in pain control and subsequent disability by fostering priority to pursuing #valuedlifegoals “

30) I agree w/ Gordon Waddell who wrote the Foreword to the 1st 2 Eds of ROS in 1996 & 2007 that the may be a non-clinician

31) #painpatientadvocate who doesn’t have to update their priors or de-implement low-value care since they have no #vestedinterest or #statusquo bias for putting procedures > people.

32) “the heart of what health care is all about” “rehab is not a separate 2nd stage intervention after “proper” treatment” @jasonsilvernail @benedsmith

33) As Chris Main said GW nailed it “His further aspiration of removing most LBP from the clutches of clinicians)” is what we need now. #EveryMoveCounts #ncds @M_Stamatakis @fiona_bull @MyCuppaJo

34) Main shares “progress towards guided self-management can be embedded. Indeed, it seems very probable that primary care post-CoVID-19 will look rather different.” #creativedestruction of low-value care is my wish shared here w/ Moseley, P Silva et al https://youtube.com/playlist?list=PL9VnxSziCEchJatAUXP-JpMxnxBGkXmAA