A Pain Clinic Case, Lessons for Clinicians and Multimodal Care

Alison shares notes from a patient with an exercise history and good self-efficacy. After four months she reported fewer emotional lows, harder Pilates exercises, gardening paced up from five to 30 minutes instead of two-hour sessions followed by flare-ups, and lifting a dining chair again, yet no real reduction in pain. The focus stays on function, with pain scores hopefully falling over time. For clinicians frustrated by slow progress, the advice is to respect yellow flags, lower expectations, and refer patients with high catastrophizing early to a psychologist or pain clinic rather than waiting three to six months. Resources include Explain Pain, the Protectometer, a pelvic pain book by Adriaan Louw and colleagues, a Lorimer Moseley lecture and Alison's own book, Pain Heroes. Multimodal care starts with listening, empathy and a therapeutic alliance, then diagnosis, a plan and pain education, and only then each clinician's own tools. Sometimes the most valuable goal is an effective psychology referral.