Less of my patients are left behind with their pain
Laure HAGGENJOS[1]
As of several days ago, I am the 77th certified somatosensory therapist of pain (CSTP®). 15 years ago, I attended one of the first courses in Switzerland. I could see back then the disturbing effect this new approach had on the therapists, as it challenged with by the new way of thinking. It also raised many unanswered question for myself. The course notes were quite difficult to understand.
Then came the first edition of the manual (Spicher, 2003). It was perfect for me to solve cases of simple axonal lesions (recents and localized) unfortunately not all the others … ! Then the Atlas (Spicher et al., 2010a) and the second edition of the manual (Spicher & Quintal, 2013) came out. As a complement to my job as an occupational therapist in hand rehabilitation, I took a course and was certified in neurorehabilitation. I learned new techniques and enriched my experience, generating new points of view.
Presently I have 30 years of professionnal practice behind me. The patients that I couldn’t help, that were left behind, are the ones that pushed me toward getting the certification.
To me, somatosensory rehabilitation of neuropathic pain always had a special place amongst the rehabilitation field for the following reasons:
A: This method is the most recent of those I use in my practice. It was built on the foundation of old research (Létiévant, XIXth century), with continuous thinking from its founder spanning over more than 15 years. The results were carefuly put together with the help of his collaborators (Quintal et al., 2013; Spicher et al., 2015; Spicher et al., 2016).
B: It concerns a terra incognita, something invisible, missunderstood, neglected and sometimes even denied by medical doctors and therapists. Just as the lymphatic system and manual lymphatic drainage were slow to be recognized, or the even earlier example of the slow acceptance of psychoanalysis, the role of somatosensory rehabilitation of neuropathic pain and the underlying mechanisms seem to have been missed by others probably for similar reasons.
C: This method needs to be well understood to bring good results: superficial understanding isn’t enough. It asks for rigorous work, persistence or even relentlessness to understand its area of application, the skin. Practice and repetition are necessary to discover the biggest organ of the body, in all its depth and the varied nerve pathways, its anatomophysiology, so to say. The same persistence and rigour was also necessary in learning the assessment procedure and the different modalities of the numerous treatments. However, it is a great satisfaction to see that in the last two years, the duration of my treatments have decreased and that I have less limitation in terms of what I can do to treat neuropathic pain.
D: It needs a stronger collaboration between all the people involved with the patient than most of other methods. It is why I always have some clearly written papers, to hand out or attach to a report to explain the approach to patients, other therapists and medical doctors.
E: The method is opposite to traditional healthcare: where the patient is constantly encouraged to attend treatments using movement, touch, massage, etc… Therapists and medical doctors often value a “hand-on” care delivery to solve the issue. Here, I have to teach that not touching a specific area is the treatment (Spicher et al., 2010b). It is the improvement of my knowledge in anatomophysiology and the treatment techniques of the method that gave me confidence even while not doing much “to” the patient like we are expected to.
F: A bigger share of the treatment is the patient’s responsibility. Here, he has to learn how to wake up and change his invisible nervous system himself. 90 percent of the rehabilitation is done by the patient himself at home. Thanks to the way the treatment is lead, I have richer and deeper verbal interactions with my patients.
Nowadays, less of my patients are left behind with their pain.
References
Quintal, I., Noël, L., Gabe, C., Delaquaize, F., Bret-Pasian, S., Rossier, P., Annoni, J.M., Maupas, E. & Spicher, C.J. (2013). Méthode de rééducation sensitive de la douleur. EMC- Kinésithérapie-Médecine physique-Réadaptation, 9(1), 1-16 [Article 26-469-A-10].
Spicher, C. (2003). Manuel de rééducation sensitive du corps humain (1ère édition) – Préface : Prof J.- P. Roll. Genève, Paris : Médecine & Hygiène translated in English as Spicher, C.J. (2006). Handbook for Somatosensory Rehabilitation – Foreword: Prof A.L. Dellon. Montpellier, Paris : Sauramps Médical.
Spicher, C. & Quintal, I. (2013). Rééducation sensitive des douleurs neuropatiques (2e édition) – Préface : Prof R. Melzack. Montpellier, Paris : Sauramps Médical.
Spicher, C., Desfoux, N. & Sprumont, P. (2010a). Atlas des territoires cutanés du corps humain : Esthésiologie de 240 branches. (1ère édition) – Préface : B. Moxham. Montpellier, Paris : Sauramps médical.
Spicher, C., Delaquaize, F., Antiglio, D., Crohas, A. & Vianin, M. (2010b). L’allodynie mécanique : une contre-indication temporaire pour certains traitements physiques. Mains libres 5, 199-205.
Spicher, C., Quintal, I. & Vittaz, M. (2015). Rééducation sensitive des douleurs neuropathiques (3e édition) – Préface : Prof S. Marchand. Montpellier, Paris : Sauramps Médical.
Spicher, C.J., Fehlmann, P., Maihöfner, C. Sprumont, P., Létourneau, E., Dyer, J.O., Masse, J., Lopez-Solà, M., Maupas, E. & Annoni, J.M. (January 2016). Management Algorithm of Spontaneous Neuropathic Pain and/or Touch-evocked Neuropathic Pain illustrated by prospective observations in clinical practice of 66 chronic Neuropathic Pain Patients. e-News Somatosens Rehab, 13(1), 5-33.
[1] OT HES, Certified Neurorehabilitation, CSTP® ; Cabinet privé, Espacité 3 ; CH - 2300 La Chaux-de-Fonds (Switzerland) ; laurehaggenjos@hotmail.com
