Abstract of The Week: Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain

ABSTRACT: Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study

Jorge Fuentes, Susan Armijo-Olivo, Martha Funabashi, Maxi Miciak, Bruce Dick, Sharon Warren, Saifee Rashiq, David J. Magee, Douglas P. Gross (April 2014)

This study looked at some of the ways to encourage the therapeutic alliance with patients and found that a good therapeutic alliance reduces pain intensity and muscle pain sensitivity in patients. The design for the study was for one session of active or sham interferential current therapy and measured pain intensity and pressure pain threshold.

cropped shoulder
The goal of the study was to test the immediate effect of an enhanced therapeutic alliance.

The study used the following to enhance the therapeutic alliance:

  • 10 minutes of questions about symptoms, lifestyle, and cause of condition.
  • Active listening
  • Tone of voice
  • Eye contact
  • Physical touch
  • Empathetic statements such as, “I can understand how difficult LBP must be for you.”
  • The physical therapist stayed in the room during the entire treatment and measurement outcomes.
  • Verbal interaction encouraged during treatment.

The conclusion from the study was that the “context in which physical therapy interventions are offered can dramatically improve therapeutic effects.”
In discussion, the authors suggest that, “There is a difference between interacting and engaging and between connecting and meaningfully connecting. All require communication, but engaging and meaningfully connecting enhance the relationship.”

Therapeutic Alliance

“Personal characteristics of clinicians can influence treatment outcomes either positively or negatively. Some potential behavioral styles may favor or inhibit placebo responses.”

“Inappropriate comments may exacerbate symptoms.”

And, this is true for every service delivery, including teaching and retail services, not just physical therapy.

I will be referring to this article in one of the three sessions that I am presenting at the Tennessee Physical Therapy Association meeting next month, April 8 -9th, 2016 in Nashville. If you are there, come by the NAIOMT booth to visit Bryant Miller or myself in-between sessions.

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-Rebecca Lowe, PT, COMT, CFI, FAAOMPT

Rebecca Lowe, PT, COMT, CFI, FAAOMPT graduated from the University of Maryland at Baltimore in 1993 and is certified and fellowship-trained through the North American Institute of Orthopedic Manual Therapy. She serves as a NAIOMT faculty and Clinical Fellowship Instructor and is a Fellow of the American Academy of Orthopedic Manual Therapy. She has published two articles on adhesive capsulitis of the hip, recently published Restoring Hope in Chronic Pain: A Whole Person Perspective from an Orthopedic Manual Physical Therapist (OMPT), spoken for professional organizations and her community, and owns Manual Therapy of Nashville. Rebecca is passionate about orthopedic manual physical therapy, dry needling, innovative research, and teaching.





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