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Do we need Motivational Interviewing in Physical Pelvic Pain Therapy? Reasons to improve communication in order to make physical therapy interventions for persistent pelvic pain more acceptable and efficient
IUGA Academy. Halbedl H. Jun 30, 2018; 212999
Topic: Pelvic Pain
Heidi Halbedl
Heidi Halbedl

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Do we need motivational interviewing in physical pelvic pain therapy? Reasons to improve communication in order to make physical therapy interventions for persistent pelvic pain more acceptable and efficient

Halbedl, H1

1: FH Joanneum Graz

Introduction: Motivational Interviewing (MI) is effective in treating chronic pain, well-being, and self-efficacy for persons with persistent pain. There is clear evidence on the effectiveness of MI and physical programs in pain rehabilitation. The biopsychosocial understanding of chronic pain applied in physical therapy practice is mediated by communication. When therapists make appropriate suggestions for lifestyle modifications they support change management. Pain management in a biopsychosocial understanding is change management. Even if physical therapists communicate in a friendly way they may not contribute to self-management of pain. Negative beliefs, fear, and stress, catastrophization, hypervigilance to pain of patients with chronic pelvic pain demand an efficient way of interaction to support patients on their way out of the circle of chronic pain. Therefore, Comprehensive Physiotherapy is suggested when it comes to chronic pain syndromes: appropriate communication supports rehabilitation, reduction of fear, and contributes to central desensitization.

Objective: What makes MI relevant in chronic pelvic pain? The main objective of this article is to determine the necessity of evidence for MI practice in physical therapy of chronic pain of Provoked Vulvodynia (PVD).

Methods: I discuss clinical observations with results of a literature study of published writings in the field of MI and a review of recent studies concerning pain in PVD.

Results: In women with PVD hypervigilance, fear of pain, catastrophizing and self-efficacy are correlating with pain while anxiety, self-efficacy, avoidance are cognitive, affective correlates of sexual function in women. In pelvic pain patients motivation to manage pain is poor and a change of maladaptive behaviors, elicit ambivalences and enhance self-efficacy for making changes and self-management of pain. Cognitive and behavioral treatment approaches content strategies to help the patients to manage more effectively chronic pain and improve their well-being. In physical therapy we use cognitive approaches to address the complexity of chronic pain and help patients to become aware of the opportunities for change and manage more autonomously their physical and mental suffering. Motivational interviewing can be invaluable cognitive-behavioral approach for patients with chronic pelvic pain in physical therapy to avoid nocebo in communication. Communication Skills are recommended by systematic review because of the major role of attitudes and behavior in the placebo response and the meaning of communication for interaction and therapeutic efficacy and change of patient. Also, in physical therapy for chronic pelvic pain we need elements of MI to accompany chronic pelvic pain patients in a process of change in their ways of managing pain, when they are ineffective and aggravating their situation.

Conclusion: Further research is required, since therapeutic interaction could be a key factor in physical treatment of chronic pelvic pain and PVD. Professional communication is an important cognitive treatment approach in physical therapy, especially when there is a poor motivation profile and the challenge of managing chronic pain.

Disclosure:

Work supported by industry: no.

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