COCA 6^th Biennial Conference
A Great Success
By Stan Innes BAppSc(chiro), MSc(psych)

The 6^th Annual Conference has come and passed us by. It was officially opened by Mr Greg Tweedly, Chief Executive, Victorian Work Cover Authority. His remarks set the tone of the conference with a reflection on the current state of the rehabilitation setting and VWA’s desire for the best outcomes for patient and practitioner alike when dealing with chronic / persistent pain clients.

The VWA Clinical Framework was explored from a number of perspectives. Dr Lynda Walshe (Osteopath) reflected on its implementation from a clinician’s perspective. Her discussion was both informative and heartening as she outlined the challenges of the persistent pain sufferer and how the Clinical Framework had enabled an evidence-based structure to provide improved outcomes for both patient and practitioners. She illustrated these by sharing openly with us, a diverse range of clinical experiences.

Dr Peter Cotton (psychologist) outlined for the conference the current state of psychological interventions for persistent pain sufferers. He began by describing the development of the most commonly utilised method, Cognitive Behavioural Theory. Interestingly, he drew a clear line between theory and practice. His discussion of situations where a co-management program that may be appropriate was enlightening.

Ms Susan Slade (physiotherapist) caught the audience by surprise with her review of the evidence for trunk strengthening exercise for chronic low back pain. The potential for functional rehabilitation in carefully selected populations was nothing short of astounding and generated many a clarifying question. It expanded our thinking of the capacity for the injured worker’s exercise limits.

I was especially looking forward to hear from Dr de Graff, the Medical Director at Cedar Court Health/South Rehabilitation Hospital, having been fortunate enough to work in a pain management clinic in the past. He detailed the breadth of the chronic musculoskeletal pain management challenge. He reviewed the evidence to date for multidisciplinary pain management programs and the challenges persistent pain sufferers present to teams at Cedar Court. He concluded with a frank admission of the need for further research in the efficacy of such programs at both team and individual therapy levels.

Kermit the frog celebrated his 50th birthday by assisting Dr Melanie Cameron’s lively and colourful presentation on chronic musculoskeletal pain. Kermit and friends (more than ably abetted by Dr Cameron) delightfully illustrated the detection and recognition of psychosocial factors in the light off recent studies into the concept of “yellow flags”. She suggested a reframing of the practitioners role, from one of an authoritarian figure to that of a therapist who walks alongside the client through the quagmire of chronic musculoskeletal pain. I will have forever echoing in my mind her question “is it our job to kiss frogs?”.

Working with chronic pain sufferers in the workers compensation system is never easy. Dr Henry Pollard lent to us his considerable expertise and experience in these matters. He employed a case-based approach to highlight common pitfalls in the documentation and management process. His no-nonsense concrete suggestions for the use of evidence based management and how to employ it in presenting treatment outcomes to those reviewing care plans was insightful to say the least.

David de la Harpe outlined the prerequisites for spinal surgery in patients with chronic spinal pain. He approached the topic with his usual candour and detailed the role of physical therapies in the pre-operative and post-operative stages. It was a session not to be missed.

Doctors Walker and Cameron moderated the Saturday afternoon ‘Original Research Papers Session’. The breadth and quality of papers presented was a reflection on the maturing of our professions. This was also mirrored by the poster presentations. All presenters are to be congratulated.

This was followed by the Grand Rounds Panel, hosted by Dr John Reggars, in his own inimitable fashion. Several complex chronic pain cases were discussed at length. While tinged with humour, the stark relevance to daily practice of these cases kept the tone serious. Dr. Reggars would make an able replacement for Geoffrey Robertson in “Hypothetical”. Often cases leave our rooms and we are unaware of their future journey. It was sobering and thought-provoking to see the consequences from well-meaning interventions that ultimately resulted in poor outcomes. Even more confronting was the myriad of options that the Panel proffered that may have prevented such results. Many were not as high on my radar screen as they should have been. I have to admit to a touch of “cultural cringe” as they questioned many of the treatment interventions I would have persisted with.

The keynote speakers were sensational. Dr Mitch Hass, who has published extensively in the peer-reviewed literature, reviewed the evidence for the role of manipulation and its effectiveness. I like to think of him as the person who strengthened how we think inside the circle. Professor Waddell caused us to think outside the circle. i.e., beyond the scope of only hands-on therapies. It is not possible to do either person justice in this précis. You simply had to be there. These men were a wealth of knowledge and experience. They were only too happy to dialogue / discuss / argue away from the podium as well.

To top it all off, as well as catching up with old friends, Dr Peter Larkins was an extremely entertaining and engaging speaker and seemed to take extra delight in having an educated audience with whom he could relate to. He was well versed with many a humorous tale but was at his finest discussing the cutting edge of sports medicine interventions and practice at the elite level. A top night, you should have been there!