Spine models are excellent tools for improving patient engagement and outcomes. They make it easy for the patient to understand their condition and the proposed treatment plan better. However, like any tool, they can also be used in a way that can hold back patient improvements. This is a guide for how to use spine models to their full potential in your treatment plan, while avoiding the nocebo response.
Models and effective treatment
Most of your patients have a fairly limited understanding of spine anatomy. The mechanisms of their pain or discomfort are a mystery to them, and they come in need of a fix. The best treatment, however, isn’t the one that simply reduces or manages the pain. It’s the one that also explains how the treatment is done.
A few years ago in Economics, an excellent paper was published by Daniel Hausman called ‘Why look under the hood’. In it he put forward a similar point; if you’re testing out a used car then a test drive isn’t enough, you need to look under the hood at what is underlying the car’s performance to know what might happen in the future. His point was that it’s important to understand the mechanisms underlying a phenomenon to fully get to grips with it.
We can’t show a patient under the hood without invasive surgery because the body does not have a hood to open. However, we can show them with a model that represents the inside, so they can understand the mechanisms contributing to their pain. This will allow them to clearly see and engage more with their treatment plan. It also may allow them to feel confident in reporting new developments in their condition.
How to incorporate models in your treatment plan
Here’s a way to incorporate this explanation into your treatment plan.
- Watch the patient move, observe their posture and facial expressions. Notice their symmetry and how they get up from a chair. This will help add context to their personal account of their condition.
- Ask the patient for their narrative. Their account of their history and when the pain or discomfort started is your second piece of evidence.
- Touch where the patient is experiencing discomfort and feel whether there are any tissue abnormalities. Notice how they react to your touch.
- Assess their condition based on these three evidence points, and develop a treatment plan. Communicate what is causing their condition with the appropriate spine model, and how the treatment plan empowers the patient to reduce their discomfort.
Watch Stuart McGill’s use spine models in his explanation here:
Avoiding the nocebo response
Michael Sullivan’s landmark paper, on catastrophizing and the nocebo response, showed that spine specialists need to be careful in how they communicate a patient’s condition. Using negative, pain-focused language can negate the benefits of treatment and leave the patient feeling unable to improve their condition.
A growing trend is seeing specialists criticising spine models as contributing to catastrophizing. They argue that spine models which show defects encourage patients to associate their pain with a physical, unchangeable condition – hampering treatment. While this is certainly possible, any tool used inappropriately can cause unwanted effects. Spine models only contribute to the nocebo response when used incorrectly and under a poor practitioner.
Models should be used empower and educate the patient, not scare them. The specialist must make it clear that the treatment plan will work and use spine models to demonstrate why. Models only contribute to catastrophizing when they exaggerate and embellish the pain causing aspects of their anatomy.
At Dynamic Disc Designs we take great care to ensure our models are the most anatomically accurate on the market, and only represent spine defects appropriately to aid the specialist.
We welcome feedback from specialists in how we can further support them to avoid the nocebo response. Get in touch here with your suggestions or tell us how you incorporate models into your treatment plans.