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Dear Doctor, 

 

Peek Practice offers a contemporary evidence based approach to management of spine and and complex pain disorders. 

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It is our approach to work collaboratively with our patients' healthcare team. In keeping with current evidence informed practices our aim is to provide care that is; 

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Patient-centred

Collaborative 

Evidence-based

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There are a myriad of treatment approaches for the management of spine disorders and I’m aware of the potential minefield of uncertainty this creates when making referrals. What is clear and evident in the literature is that a multidimensional, biopsychosocial approach is considered contemporary best practice for the management of spine pain. Thereby bridging the gap between general practice and specialist services more comprehensively.

 

Pain science is a rapidly expanding area with considerable advances in the understanding of pain mechanisms, most notably in the clear delineation of terminology with respect to nociception and pain.

 

The interesting part of this is that most patients still view their own pain solely as a direct result of biological factors (damage or disease). Whilst this may well be the case in the early phases of acute pain, we now know that persistent pain is often not solely the result of nociceptor generators. This is one area in which I would like to assist your patients. As well as providing appropriate reassurances, education is now considered a key issue in pain management.  The recognition and assessment of the “yellow flag” components of the pain experience are considered pivotal in the prevention of persistent pain.

 

So, what’s different about this approach and how will your patients benefit?

 

A key component of this model of healthcare is to provide a patient-centric approach, in keeping with the foundational pillars of evidence-based practice.

 

This clinical approach encompasses the following;

 

  • Comprehensive case history (including psychosocial baseline measures).

  • Orthopaedic and neurological assessment.

  • Educational emphasis back to the patient when formulating an opinion or diagnosis (this considers the impact of complex language and “over emphasising” incidental asymptomatic spinal changes that are not necessarily relevant to the presentation or prognosis).

  • Cognitive functional therapy (utilises principles of cognitive behavioural therapy and acceptance and commitment therapy with movement to reduce fear).

  • Manual therapy (where indicated*) to provide a means of leveraging analgesia in the early stages of management.

  • Harness and encourage the development of patient self-efficacy with emphasis on active coping strategies and patient autonomy.

  • Targeted rehabilitation with the aim of restoring function through mobility, activation and strengthening activities in keeping with patient goals and preferences.

 

As a member of a multi-disciplinary team for patient care I will undertake to provide you and your patient with the following;

 

  • Up to date and regular reporting of patient progress.

  • Up to date peer-reviewed evidence and rationale supporting management strategies.

  • Patient choices, preferences and goals as key components to the management plan (including a contemporary approach to informed consent).

  • Outcomes-based assessment and reporting and relevant indicators of progress.

  • A working case formulation-based diagnosis that accounts for the multidimensional nature of the pain experience.

 

In addition I will be seeking your advice and counsel when onward referral may be necessary.

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This clinic works with the principles of the International Chiropractic Education Collaboration.

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I would be very happy to discuss this further with you to provide you with further information or material that may interest you.

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Yours Sincerely,

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Nigel Peek 

MNZCA MA.Tech Chiro (SA)

PGCertHealSc Western Acupuncture (AUT)

PGCertHealSc Pain and Pain Management (Otago)

 

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References

 

1. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 2018;391(10137):2368-83.

2. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356-67.

3. O'Sullivan P, Lin I. Acute low back pain: Beyond drug therapies. Pain Management Today. 2014;1(1):8-13.

4. O'Sullivan PB, Caneiro JP, O'Keeffe M, Smith A, Dankaerts W, Fersum K, et al. Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical therapy. 2018;98(5):408.

5. Murphy DR, Justice BD, Paskowski IC, Perle SM, Schneider MJ. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States.  Chiropr Man Therap. 19. England2011. p. 17.

6. Deyo RA. Real help and red herrings in spinal imaging. N Engl J Med. 2013;368(11):1056-8.

7. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med2017. p. 493-+.

8. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine. 2017;166(7):514.

9. Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463-72.

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