Basic course about Somatosensory Pain Rehabilitation Freiburg 2022

Erica Bossard & Catherine Couture

MSc(A) OT, CSTP®, School of Rehabilitation, Faculty of Medicine and Health Sciences, McGill University, Montreal (Qc), Canada

The 138th Basic course about Somatosensory Pain Rehabilitation took place in Fribourg, Switzerland in September 2022. For most participants and the lecturers, it was the first in-person course since the beginning of the COVID-19 pandemic. As current occupational therapy students from McGill University in Montreal, Canada, we had grown accustomed to meeting our colleagues and classmates in a virtual setting and were thus excited to take part in an inperson training. What a joy it was to meet international colleagues in person after two years of online trainings and courses!

During this 4-day course we had the pleasure of meeting a diverse group of healthcare professionals (including occupational therapists and physical therapists) and scientific collaborators from all around the world, such as Spain, Belgium, Brazil, Germany, Switzerland, and the Netherlands. The mix of personal and clinical experiences as a result of this diversity gave rise to fruitful exchanges both in formal and informal moments, leading to an even richer learning experience.

The course opened on a quote, read aloud in each participant’s native language, highlighting the importance of the therapeutic relationship when working with people living with neuropathic pain. It set the tone for the journey that we were about to embark on together during this 4-day course. We were encouraged to keep this quote present in our minds throughout the course and beyond.

“When the veil is finally torn, it is il momento giusto to interrupt our planned therapeutic processes and simply listen, and if possible, hear the unfathomable otherness of the other during that second when the rotation of the earth stops imperceptibly. When the patient reveals the most intimate part of their being to us, it is the moment when we fall behind and then have to say to the next patient: I had an emergency. At this precise moment, the patient will enter into their own rehabilitation process: it is the corner stone of the effectiveness of his treatment.” (Spicher et al., 2020a).

After getting to know each other, we dove right into the theoretical content of the course: understanding somaesthetic and neuropathic conditions, and the role of the Somatosensory Therapist of Pain (STP) in their evaluation and treatment. The course was organized in a way that allowed for participants to build upon what was learned the day before, from simple to more complex concepts, intertwined with practical workshops and live clinical observations. By the end of the 4-day training, we were all well versed in the method of Somatosensory Pain Rehabilitation (SPR), thus, in evaluating and treating patients presenting with somaesthetic conditions (Stage I) or simple mechanical allodynia (Stage II) to increasingly more complex neuropathic conditions (Stage III, IV, V) and their neurophysiological etiologies.

The basic course schedule was planned in a way where mornings were mostly spent immersed in theory and its supporting evidence, whereas afternoons purposefully focused on clinical workshops, case study discussions, and live clinical observations.

Every day, lunchtime was an opportunity to connect with one another while tasting local Swiss foods. It was a time for sharing informally about our clinical and research experiences and to learn about each other’s culture and interests.

The afternoon session was devoted to the practical application and practice of the assessment and treatment methods we learned about in the morning. These workshops were also an opportunity to learn about the other course participants’ experiences. This time spent working in smaller groups helped to clarify practical concerns and to collaborate to solve problems. Of note, we were introduced to the Atlas of Cutaneous Branch Territories for the Diagnosis of Neuropathic Pain (Spicher et al., 2020b), an essential work tool used multiple times a day by STPs. We were able to directly try out our newfound knowledge of the Atlas during the practical sessions, especially when learning how to map aesthesiographies and allodynographies.

In the afternoons, we also had the opportunity to observe sessions with patients of the Somatosensory Rehabilitation Centre to observe and learn from experienced Certified Somatosensory Therapists of Pain (CSTP®) and their patients. The therapists were gracious with their time and answered questions after the sessions to ensure a good understanding of the SPR method.

Another essential assessment tool the group was presented was the McGill Pain Questionnaire (MPQ). This questionnaire is available in multiple languages and allows the patients and the therapists “give words” to the bizarre, uncomfortable, or painful sensations they experience (Melzack, 1975). For most patients, this tool validates their pain experience and facilitates the therapeutic relationship. Furthermore, one course participant who works in a hospital in Switzerland, pointed out that she would aim to use the MPQ more frequently in her place of work as it helps to “build a shared vocabulary” with patients and among colleagues.

Many of our fellow course participants are used to treating a variety of conditions in their practice. As the course unfolded, more and more patients came to their minds when thinking about who they could use the SPR method with. As we, occupational therapy students, are getting ready to start our final internship at the Somatosensory Rehabilitation Centre, we feel well equipped to taking on our first patients presenting with neuropathic pain conditions. We will continue to learn from our colleagues, local and international, as we aim to grow into compassionate therapists using evidence-based methods such as the SPR method, setting the stage for il momento giusto for our future patients.

References

Melzack, R. (1975). The McGill Questionnaire: Major Properties and Scoring Methods. Pain, 1, 277-229.

Spicher, C., Barquet, O., Quintal, I., Vittaz, M. & de Andrade Melo Knaut, S. (2020a). DOULEURS NEUROPATHIQUES : évaluation clinique & rééducation sensitive (4e édition) – Préface : F. Moutet. Montpellier, Paris : Sauramps Médical.

Spicher, C.J., Packham, T.L., Buchet, N., Quintal, I. & Sprumont, P. (2020b). Atlas of Cutaneous Branch Territories for the Diagnosis of Neuropathic Pain (1st English edition stemming from the previous 3rd French edition) – Foreword: B. Kramer. Berlin, London, New York City, Shanghai, Tokyo: Springer-Nature.