PainCloud 2018 conference: Changing how pain and function are treated

Nearly 150 clinicians attended PainCloud 2018 at the Thon Conference Universitetsgaten in Oslo, Norway on the weekend of April 21-22.

The speakers included Dr. Jason Silvernail (U.S.), Lars Avemarie (Sweden), Dr. Mary O’Keeffe (Ireland), Dr. Silje Endresen Reme (Norway), Sigurd Mikkelsen (Norway), Derek Griffin (Ireland), Joletta Belton (U.S.), Todd Hargrove (U.S.), and Dr. Tasha Stanton (Canada).

In some ways, the conference was very similar to the San Diego Pain Summit. A presentation, followed by Q&A, break, repeat. But I was more interested in how much do European physiotherapists and other clinicians understand pain, disability, and exercise compared to those in the U.S. and Canada. How would they use that knowledge in their practice?

After a few years of being Facebook friends, I finally got to shake hands with Ole Morten Salte, one of the founds of PainCloud.

After he graduated as an osteopath in 2014, Salte worked at a clinic in Norway where he was gradually transitioned from the biomedical approach to understanding pain and health to the biopsychosocial (BPS) model.

“I was eager to start implementing what I had learned, but unfortunately this didn’t go well with my boss,” Salte told Massage & Fitness in an online interview. “I had several conflicts with my boss about how I worked and the accumulation of this made me quit the job. The clinic was within the biggest chain of private musculoskeletal clinics in Norway. The focus on making money really compromised the implementation of a biopsychosocial approach.

“I’m also a certified personal trainer, and after I quit the job and told my wife that I didn’t want to be a part of this kind of business model,” he continued. “She was well aware of my passion about pain and pain management and convinced me to continue to work as an osteopath. I decided that if I was going to work in this kind of paradigm, I would try my best to change it.”

Before PainCloud, Salte started with bits of illustrations that he shared on social media about pain. Later, he made a webinar subscription service in an attempt to make a bigger impact. Even though he had Gregory Lehman for an interview, the webinar didn’t reach out to as many physios as Salte wanted. And so, he discontinued it.

“And I started Paincloud,” Salte said.

Salte said he started the first PainCloud conference in 2017, and it was a success.

“Now we just had our second convention. Like last year, it was a successful event. I have now gathered a team and we are evolving Paincloud by working on new and exciting projects, like a monthly research review, podcast, online course,” Salte said. “Paincloud is no successful business in terms of revenue, and my intentions have never been running the financial aspect of the company. It’s a passion-project where I rather spend the money on making high-quality services to facilitate as much change as possible than becoming rich.”

He believed manual therapy professionals can play a crucial role in helping people recover from pain, but said that “we’re not as efficient in helping people as we could and in private practice the financial side of this is a big restriction for change.”

“I also think it’s a shame that thousands of new therapists graduate each year with an outdated understanding of pain and pain management,” Salte said. “Even though I had ambitions of changing the world by myself when I started Paincloud, I realized that won’t happen, but Paincloud can be a part of a collective effort to make meaningful change. A sobering thought is that, in the end, it’s the patient who suffers from our lack of competence and the slow changes of the education systems. Paincloud is an option for therapists to take on a modern understanding of pain and pain management when the educational system can’t.”

Tim Hustad, a naprapath from Hammerfest, Norway, helped Salte started PainCloud and was the MC for PainCloud 2018.

“After getting to know him, I thought he would be an excellent MC at our conferences,” Salte said. “He and a colleague developed the educational model called SERA, and it was my pleasure to share it on the Paincloud blog.”

Hustad said that he does not know how updated Norweigian manual therapists are updated with pain science compared to the U.S. and Canada, but having followed social media discussions about pain, he said that “We are not much better or worse off than most other countries.”

“Something tells me that we might be well-informed or exposed to a lot of information, but we don’t seem to take a lot on board,” Hustad said.

He said he had an encounter with a naprapathic at a conference in April where physiotherapists Tim Beames and Wim Dankaerts were speaking, who are strong advocates for change in how clinicians should treat and communicate about pain. One of Hustad’s colleagues took a peek at what notes the naprapathic was taking, but he didn’t take any notes in the first few talks.

“The third talk was a manual therapist who spoke about what specific effects we can expect from manual therapy, and how contextual effects play a major role. The only note made from that talk and from the whole day was, ‘We should continue to manipulate the spine!’”

“For me, the challenge is not so much in making information available, but rather actually affecting a predetermined mind. I guess this example in some ways sums up the brick wall that stands in the way of behaviour change, and in the way of the paradigm shift many of us long for,” Hustad said.

Psychology professor Silje E. Reme, talked about how the information and research of the BPS model could be translated into practice and influence change in the government health care policies.

“I hope that my research will provide the right kind of help to patients with chronic pain to help them gain or regain employment,” Reme said. “The model I presented, Individual Placement and Support (IPS), is a new and innovative way to help people in to employment by providing individual job support integrated with treatment on the patients’ premises. The preliminary results from the trial appears promising, and if the findings are replicated, I hope this new approach to patients with chronic pain and no employment will be implemented in the Norwegian healthcare system.”

“However, as far as I know, it is only offered to patients with mental health problems, not patients suffering from chronic pain,” she continued. “So this initiative in Norway is the first attempt to test IPS for patients with chronic pain. Other approaches with some similarities to the IPS, have been tried out other places with similar promising findings. One example is an intervention involving integrated care for patients with chronic low back pain in the Netherlands.

The future of PainCloud

Salte said that he and his team are in the late stages of organizing a PainCloud convention in the U.K. in November.

“We have acknowledged that one of the biggest hurdles for attending our conferences is the location. We want the information to be available and be exposed to as many therapists as possible, and one of our strategies is to start organizing events in other countries to reach more people,” he said.

Despite the high-quality delivery and information that the speakers brought, Salte thinks that the traditional format of the conference is “too passive,” where the audience listens and the speaker projects.

“I believe that changing the structure of the conference from passive to interactive will lead to more return for the participants in terms of learning,” Salte said. “We want the participants to be active and reflective to facilitate more learning. That’s why we had a pilot project this year with group discussions where a pair of speakers sat down with a group and discussed topics the participants wanted to discuss.

“We also increased the time between talks to give the participants time to discuss. Instead of having questions after each talk, we combined the two talks and had a 10- to 15-min Q&A with two speakers on stage. This made it possible for two speakers to answer the same question, and add different perspectives to the question. We also organized a social happening on Saturday evening to further give the participants a chance to discuss with each other and with the speakers.

“I am grateful for the support and help I have gotten from Tim Marcus Valentin Hustad, Lars Avemarie, Sigurd Mikkelsen, Kjartan Vibe Fersum, Morten Ekornsæter, and Håkon Fotland. These are people that has inspired, supported, and helped me a lot the last three years.”

More photos from PainCloud 2018 is on Flickr.