Developing an integrated Osteopathy and Acceptance-informed pain management course for patients with persistent pain.

Abbey, H (2017) Developing an integrated Osteopathy and Acceptance-informed pain management course for patients with persistent pain. Doctoral thesis, University of Bedfordshire.

Hilary Abbey Thesis 2017.pdf

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Purpose: This study explored therapeutic processes associated with developing a course for patients with persistent pain which integrated osteopathic treatment with Acceptance and Commitment Therapy (ACT). This 'third wave’ cognitive behavioural approach is effective for a range of physical and psychological problems, including persistent pain, and congruent with osteopathic principles of holism, function and agency, which provided a theoretical basis for developing an integrated intervention to promote resilience and well-being. A qualitative case study was conducted as part of a developmental research programme to explore how ACT could be integrated with osteopathic treatment for individual patients, and with what effects on processes and outcomes. Method: Linguistic ethnography was used to explore links between pain-related discourses, clinical decisions and responses to pain. Treatments were audio-recorded, transcribed, and coded. Extracts referring to discourses about pain experienced during manual therapy were subjected to micro-level conversation analysis, sociolinguistic analysis of participants’ roles, and macro-level analysis of links to broader healthcare discourses. A reflective diary was used to explore experiential learning and integrate auto-ethnographic information. Results: Two distinctive forms of mechanistic and facilitative pain discourse were identified. In predominantly mechanistic discourses, agency and expertise were located with the osteopath, and intention was focused on fixing ‘broken’ parts and relieving pain using ‘familiar’ osteopathic techniques. In facilitative discourses, the osteopath adopted a more collaborative role, focused on developing the patient's body and self-awareness to promote more flexible, active pain responses. Practitioner challenges included learning how to shift intention between mechanistic and facilitative interventions, a process that was enabled by mindfulness and willingness to tolerate uncertainty. Conclusions: In this study, ACT-informed osteopathy involved facilitative discourses, associated with increased patient agency and flexibility in response to pain. Further research is needed to explore whether this pattern of discourse is robust in other clinical settings; relationships between mechanistic and facilitative discourses and therapeutic outcomes; and effects of ACT training on practitioner mindfulness and attitude towards clinical uncertainty. Findings suggest that this integrated approach could expand the scope of osteopathic care for patients with persistent pain, and is worth further investigation. Keywords: Acceptance and Commitment Therapy, chronic pain, Mindfulness, Osteopathy

Item Type: Thesis (Doctoral)
Divisions: Faculty of Medicine, Health and Life Sciences > School of Medicine
Depositing User: Dr Hilary Abbey
Date Deposited: 26 Mar 2021 14:19
Last Modified: 26 Mar 2021 14:19

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