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Reply To: Biopsychosocial pain model

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Currently use a variety of “stolen” phrases from colleagues over the years as opposed to a defined “text” as part of by “rehab chat”. Concentrate on a functional deficit which the patient wants to improve (rather than my own goals) – e.g. “I want to be able to walk my daughter down the aisle”. If anything, reflecting on patient’s inactivity during the covid year has helped – “need to get yourself fitter” (trying to explain deconditioned state as a potential cause of pain). “Try walking out of your front door to the first lamp post, turn round and come back. When that is easy, try two lamp posts.”

Also use (sneaky) dietary approaches – “your body is generally not running smoothly, almost inflamed (hence can get away from the normal CRP!), try reducing this by reducing the things which drive inflammation like tobacco and processed sugar”. Often use “we” as part of the chat

Radio Analogy – “Chris Evans talking at BBC into microphone, but you are hearing shouting (as if Chris Evans is actually shouting). The problem is your own radio being turned up to much”

Cliff Analogy – “Imagine you are standing on the edge of a cliff. I then tell you to move a step forward, and you instantly feel that you will therefore fall off (and cause yourself harm). Pain is the body’s response to danger. Actually you are really 20 yrds away from the cliff edge, so stepping forwards on step will not cause harm”

Bus Driver – You are the driver of your own bus and pain is one of your passengers. Do you want it (pain) being right by the cab interrupting you ability to drive, or sat on the back seat (behaving itself). Pain is always on the bus”

If anything easier in GP setting than “one-stop OPD” because you know the background