For centuries chronic pain has been viewed as a solely biomedical issue in the tissues. However, times are changing and we now know that (chronic) pain is a complex construct in which not only physiological factors play a role. In addition, pain is influenced by psychological factors, such as thoughts and feelings, and social factors, for instance judgement and misunderstanding.
As a result of the growing knowledge about chronic pain, treatments for patients with chronic pain are also evolving. In the last decades, treatments are increasingly integrating the multidimensional biopsychosocial aspects that influence the experience of chronic pain. To support this shifting paradigm, a different structure within healthcare, based on transdisciplinary cooperation between healthcare professionals, has emerged. In a transdisciplinary team the healthcare professionals (psychologist, physiotherapist and medical doctor) have their own professional knowledge, however with flexible boundaries, collaborate intensively, draw experience from each other, and learn together. This means, for instance, that the psychologist has intimate knowledge about the neurophysiology of chronic pain and the physiotherapist also addresses psychological issues with the patient.
In this blog we would like to share our personal experiences with working in a transdisciplinary team.
“I’ve started working in this transdisciplinary team as a psychologist in May ’16. Before this job I worked as a psychologist in a ‘regular’ mental health care center. During this job, I noticed that patients with psychological problems also have physiological problems more often than not. I advised patients with chronic pain to the best of my knowledge, often based on common sense: “Keep moving, don’t overload yourself, take it easy, and don’t do too much!” However, I found myself lacking experience and knowledge to be able to fully help my patients. Moreover, there was no possibility to cooperate with other health care professionals. Now that I’m part of this transdisciplinary team, the biggest advantage is being able to share knowledge, issues and - most important - the responsibility with my colleagues. In this way, I believe we can raise the chance of a successful treatment for the patient. Moreover, having graduated as a clinical neuropsychologist, collaborating with medical doctors and physiotherapists and being involved in the biomedical aspects of health issues is a big bonus to me. I feel that it broadens my horizon as a psychologist and makes me a better, more all-round therapist.”
“During my bachelor degree the focus of the training was on the biomedical aspects of physiotherapy. However, while I was working as an intern in rehabilitation I soon found out that there is more to life than muscles and tendons, and that psychosocial aspects often influenced the treatment outcome. It was where my interest in working with patient with chronic pain was sparked. The downside of working multidisciplinary, I found, was the strict and sometimes rigid boundaries between what a physiotherapist did and what a psychologist did. After a few years of working in private practice I also joined a transdisciplinary team. To me, working with patients with chronic pain is a rewarding experience because we can provide them with tools that are, often, life changing. Especially when working transdisciplinary, because we speak the same language to the patient and collaborate so intensively. As a physio, I feel that due to the mutual learning processes I am better equipped and now have the knowledge to incorporate the psychosocial factors during physiotherapist interventions. Furthermore, one cannot know everything, and I know that when I have reached my limits on the psychosocial or medical aspects my colleagues are also involved in the treatment. We have each other’s back.”
In conclusion, even though treating patients with chronic pain in a transdisciplinary manner hasn’t been extensively studied, based on our clinical experience, we believe in its advantages compared to working mono- or multidisciplinary. In our experience, patients appreciate the intensive collaboration and we, as transdisciplinary team members, enjoy joining our forces together.
Amarins Wijma, Physiotherapist, MSc., PhD-researcher, Vrije Universiteit Brussel, Transcare Groningen, the Netherlands
Rinske Bults, Psychologist, MSc., PhD-researcher, Vrije Universiteit Brussel, Transcare Groningen, the Netherlands
2017 Pain in Motion