Chronic pain management
Information for Health Professionals
Marelle uses a biopsychosocial model for treating chronic pain, which merges all the biological, psychological and social contributions to pain conditions and can be described as an individual centered approach which considers the person, their health problem and the societal context in which the problem is experienced (Gatchel et al 2007 1)
Her approach involves:
- taking a thorough history, including all likely contributions to a patient's pain state, including the history and nature of the pain, depression and anxiety markers, meaning, fear of re-injury, and the social context (significant psychological or social contributions will be referred on to other suitably qualified professionals)
- a thorough physical examination, including screening for signs of central sensitisation
- ongoing pain education based on accurate and modern neuroscience, utilising the best available media, which may include print, audio books, video, internet and mobile phone and iPad apps (Louw and Butler 2011 2)
- encouraging and assisting patients in being active in their own self management
- individualised therapy programs, including any of the following:
- Traditional hands-on physiotherapy
- Hydrotherapy programs
- Paced exercise - home-based or supervised, individual or classes
- Graded Motor Imagery programs (www.gradedmotorimagery.com)
- Mindfulness based meditation for reducing stress, fear and ruminating patterns of pain catastrophisation (Schutze et al 2010 3)
- all therapy is delivered within a health coaching framework - this model increases the likelihood that patients will more effectively act in accordance with the treatment and lifestyle recommendations appropriate to their chronic pain conditions (see www.healthchangeaustralia.com).
Qualifications and experience:
- B. App. Sc (Physio) University of South Australia 1993
- Member of the Australian Physiotherapy Association
- Member of the International Association of Dance Medicine and Science
- Pilates training with the Australian Pilates Method Association.
- Worked in Sydney at the Royal Prince Alfred Hospital, giving broad experience in acute and chronic conditions.
- Clinical tutor for 3rd year physiotherapy students and taught biomechanics to tertiary dance students at Adelaide TAFE (AC ARTS)
- In the past 15 years she has worked in private practice and has continued her education in the following areas:
- Meditation and in particular the Mindfulness based approaches, including MBCT and MBSR from 2004-2012 (and ongoing). She is now qualified to facilitate the evidence-based MBSR program (Lazar et al 2011 4)
- Neuroscience education and training with the NOI group (David Butler). She has done several core trainings and is now a recognised provider of the Health Performance Program, a joint initiative of NOI, the University of South Australia and supported by WorkcoverSA and EML
- Health coaching qualifications with Health Change Australia 2012
Marelle has a deep respect for the unique and personal suffering experienced in chronic pain conditions. This compassion, combined with her therapeutic skill and knowledge forms the framework for helping patients move from a fixation on pain and dysfunction to integrated self-mastery, a sense of wholeness and appreciation for their own inner resources.
- The Biopsychosocial approach to Chronic Pain: Scientific Advanced and Future Directions, Psychological Bulletin 2007
- Systematic review of neuroscience education for musculoskeletal pain, Archives of Physical Medicine and Rehabilitation 2011
- Low Mindfulness Predicts Pain Catastrophizing in a Fear-Avoidance Model of Chronic Pain, PAIN 2010
- Participating in an 8-week mindfulness meditation program appears to make measurable changes in brain regions associated with memory, sense of self, empathy and stress www.massgeneral.org