I recently completed an assignment for a course on pain and it has been the best and most evidence based course thus far in my studies, it embraces and introduces the biopsychosocial model well.
So the assignment has a case study of a hypothetical chronic pain patient who is suffering from rheumoidarthritis and carpal tunnel syndrome that is preventing her from making handcrafts, and we were supposed to create a treatment plan for her.
I thought that doing a graded exposure approach for handcrafts might be an good idea. At first finding a suitable entry point for doing handcrafts and then weekly progressing it by a couple of minutes or so might be a a good idea, and possibly examining if there are postures that might make symptoms show up faster and temporarily adjusting them if she is using them while doing handcrafts.
There are other things that i would suggest her to try like exersice if she would be willing to try some mode of it be it resistance training or cardio.
But i am most interested in the graded exposure to normal activities, what do you guys think would it seem like a sensible approach and does anyone have an idea or a paper that has suggestions for why it might work if it does? Does it ''re-educate'' the nervous system to be less sensitive to nosisception or might there another mechanism at play?
Hey Tino! Sorry for my delayed response as I've been buried in systematic review research. That's great to hear about the pain course at your school. We need such courses to shift the paradigm in healthcare.
Treatment plan - out of curiosity, did the case study elaborate on other co-management strategies, such as medication, given the underlying diagnosis of rheumatoid arthritis.
Graded exposure - I think your initial approach is spot on regarding dosing her desired activities to tolerance and then slowly building up over time. Finding an entry point tends to be tricky and I usually set the expectation that I want to get a few wins under our belt for this symptomatic activity so airing on the side of easy is preferred.
I would also likely make a case for layering in hand grip exercises to aid building up tolerance for activity with her hands.
"Does it ''re-educate'' the nervous system to be less sensitive to nosisception or might there another mechanism at play?" - Out of curiosity, what led to this hypothesis?