We should not be surprised that cognitive behavioural therapy (CBT) is effective in the treatment of chronic lower back pain (GP, 27 January).
In terms of mobilising the body's awesome self-healing potential, what better way into the nervous system than through the brain-mind of the individual with the pain?
Of course, this is yet another demonstration of the need to dump Descartes and all the physical-mental and mind-body schismatic paraphernalia that comes with him.
It is remarkable that so many of our modern services are still riddled by the dictums of a long-dead (albeit brilliant) philosopher.
The quality framework is another such example of what happens when a whole-systems approach is broken up into its constituent parts and then has to be re-assembled. People then become quite scared at just how complex the world is, instead of being able to deal with it in the way that the brain has evolved to do, namely through multi-tasking and pattern matching.
We now have the ironic situation of having to lever the human condition back into the GP surgery organ system by organ system, and woe betide if the organ that is playing up is not on the list. Further, you find me any illness and I'll find you the evidence for how our neuro-immune-endocrine, hypothalamic-pituitary-adrenal axis and so on are involved to the hilt.
For as long as we continue to think that mental is separate to physical or that the physical functions of the brain-mind are delivered in ways that are more, less or differently physical to any other organ in the body, we shall continue to espouse daft dichotomising practices.
A coherent psychological service, including having front-line practitioners genned up on the latest effective techniques for dealing with somatisation, medically unexplained symptoms and comorbidities, would be highly cost-effective in ensuring better outcomes. This would not just benefit patients with traditional 'mental' illnesses, but all those with conditions where mind-brain-body states are relevant, including asthma, diabetes, CHD, cancer, arthritis, pain, dermatological conditions, irritable bowel syndrome and so forth.
If 40-50 per cent of people, with or without back pain, are told by conventionally trained doctors in GP surgeries and hospitals, inpatient and outpatient settings that they have 'nothing physically wrong with them' and are then placed in the yellow bag of indifference called the 'worried well', we will never solve the pickle that is the NHS. By doing this, we simply shunt these people around and lose them.
Dr Chris Manning, CEO, Primary Care Mental Health and Education (Primhe).