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Supporting clinicians to consider sexual function within a person-centred approach to musculoskeletal pain care

A new paper led by Professor Ilana Ackerman from Monash University and Professor Andrew Briggs from Curtin University seeks to raise awareness of the broader impacts of chronic musculoskeletal pain and provide physiotherapists with the knowledge, confidence and tools to consider sexual function as part of patient-centred holistic care. The paper was recently published in the Physical Therapy & Rehabilitation Journal.

Sexual function is an important component of overall wellbeing for many people and should be considered (where appropriate) alongside other valued activities of daily living. Although this issue has often been overlooked in musculoskeletal care, it is important to recognise that musculoskeletal pain can impact intimate relationships in a range of ways. This paper provides a much-needed practical resource for clinicians who provide care to people living with chronic musculoskeletal pain. It covers the prevalence of sexual dysfunction, strategies for sensitively raising this topic, approaches for screening, assessment and management, and potential referral pathways where a sexual function concern has been identified.

To ensure a comprehensive resource for clinicians, the paper was prepared by a team of highly experienced physiotherapist researchers with collective expertise in musculoskeletal health, pain, pelvic health and clinical education. It uses inclusive, respectful language and carefully considers diverse populations. Two hypothetical case studies provide examples of how clinical conversations around musculoskeletal pain and sexual function could be initiated in different clinical scenarios. The paper can also be used by educators to support undergraduate and postgraduate student training.

The paper can be accessed at: https://doi.org/10.1093/ptj/pzae083

This paper was also informed by systematic reviews of the prevalence and impacts of sexual dysfunction in people living with chronic musculoskeletal pain conditions, which can be accessed at:

Find a physio

The Australian Physiotherapy Association ‘Find a Physio’ directory enables people to locate a physiotherapist in a geographic area with expertise in ‘Pelvic Health’ or ‘Women’s, Men’s and Pelvic Health’.

Contact our free national Helpline

Call our team if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.


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And things you can do to manage

This blog was so full of info and strategies we had to split it into 2 parts. You can access part 1 here.

But here’s a recap: We know finding and keeping a job when you have a musculoskeletal condition like back painrheumatoid arthritisosteoarthritis and gout can be really tough.

Pain, fatigue, medication side effects and the unpredictability of your condition can all affect your ability to work.

The extent to which this happens will depend on things such as the condition you have, how severe it is, how well it’s being managed, and the type of work you do. Physically demanding work will be impacted by painful joints or restricted movements. And any work that requires you to focus and concentrate, especially for extended periods, will be affected by brain fog, pain, and lack of sleep.

The good news is there are things you can do to help manage these issues. We’ve listed a bunch of strategies here. This is part 2 of our 2 part blog.

Note: we understand that some of these strategies may not be possible for all workplaces or conditions. However the majority of them can be adapted in some way to suit your needs.

Manage your meds. Sometimes medications cause side effects like nausea, headaches, lightheadedness, and drowsiness. This can make it really hard to concentrate at work, and may in fact make it dangerous to perform some work duties such as driving or operating machinery. If you find that your medications are causing issues for you, talk with your doctor about possible alternatives you can use.

You may also need to have a review of your medications if you find your condition’s not under control or you need more help managing pain and other symptoms. Again, talk with your doctor about this.

Get a good night’s sleep. We all go through periods when sleep is elusive. Chronic pain and anxiety are just a couple of things that can affect our ability to get enough quality sleep. But sleep is important for good physical and mental health, and to give us the ‘get up and go’ we need to get to work and work productively. If you’re having issues sleeping, don’t just put up with it. There are lots of things you can do to get the sleep you need.

Take a break. Get up, move and clear your head. We all need to take breaks for our physical and mental wellbeing. So walk to the photocopier or around the block, do some simple stretches, step outside and do some deep breathing or visualisation. Whatever helps you manage your pain, fatigue, and brain fog, do it.

Dealing with time off work. We all need time off from time to time, but for many people with musculoskeletal conditions, it may happen more often than we’d like. Attending healthcare appointments during working hours or having a flare means you may go through your personal leave quite quickly. If this is a concern or problem for you, discuss your options with your healthcare team. Are you able to attend appointments via telehealth or outside of your usual working hours? An occupational therapist or physiotherapist may have some solutions for working during a flare and to reduce the pain and strain on your joints. And if you’ve disclosed your condition to your employer, discuss your concerns with them. Together you should be able to develop a plan to help you balance time off and the work duties you need to complete. One of the silver-linings of the COVID pandemic is that we’ve discovered that many jobs can be done productively from home. So working from home may be an option. As too are aids and equipment that protect your joints and save energy, or even changing the work you do at your workplace. Being proactive and knowing your rights is key to working well with a musculoskeletal condition.

Managing changes to your abilities and functioning. Unfortunately some musculoskeletal conditions will change a person’s ability to do specific tasks. For example, someone with back pain may find sitting for long periods impossible. Or a person with arthritis in their hands may find repetitive work such as typing extremely painful. Talking with an occupational therapist or physiotherapist can help you find potential solutions to these issues. Whether it’s finding new ways to do work tasks, using special equipment and aids to support you and protect your joints, or managing your pain while at work, they’ll tailor a solution to your specific needs.

These are just some of the things you can do to manage your condition and continue to work. Feel free to share the things you do to help you manage at work with a musculoskeletal condition. We’d love to hear from you!

Call our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our team. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

Making the invisible visible

Read the report based on our 2020 National Consumer Survey – Making the invisible visible – in which 66% of people said that their ability to work had been impacted by their condition/s.

Watch our webinar

Watch the recording of our webinar from March 2021, as Jessica Dawson-Field, Employment Associate, Maurice Blackburn Lawyers, takes us through employment law – rights and entitlements.

More to Explore

JobsAccess
Australian Government
JobAccess is the national hub for workplace and employment information for people with disability, employers and service providers. It provides:

  • a wide range of info and services to help people with disability find and keep jobs, get promoted to better jobs, upgrade or expand their workplace skills
  • advice on modifying your work area, talking about your disability, training for your co-workers, negotiating flexible work arrangements and returning to work
  • the Employment Assistance Fund (EAF) which gives financial help to eligible people with disability and mental health conditions and employers to buy work related modifications, equipment, Auslan services and workplace assistance and support services.
  • and much more.

Work Assist
Australian Government
Work Assist can help you stay in work if you risk losing your job through illness, injury or disability.

I have a job and arthritis: Now what?
Arthritis Society Canada

Fatigue
National Rheumatoid Arthritis Society (UK)

Sleep and pain
painHEALTH 

Managing flares
National Rheumatoid Arthritis Society (UK) 


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And things you can do to manage

Finding and keeping a job when you have a musculoskeletal condition can be difficult. Pain, fatigue, medication side effects, and the unpredictability of your condition can all affect your ability to work.

The extent to which this happens will depend on many things such as the condition you have, e.g. back pain, rheumatoid arthritis, osteoarthritis, gout, how severe it is, how well it’s being managed, and the type of work you do. Physically demanding work, such as building, nursing, and farming, will be impacted by painful joints or restricted movements. And any work that requires you to focus and concentrate, especially for extended periods, will be affected by brain fog, pain, and lack of sleep.

The good news is there are things you can do to help manage these issues. We’ve listed a bunch of strategies here. This is part 1 of our 2 part blog.

Note: we understand that some of these strategies may not be possible for all workplaces or conditions. However the majority of them can be adapted in some way to suit your needs.

Work with your healthcare team to ensure your condition is under control and well managed. This may involve your GP, rheumatologist, physiotherapist, podiatrist and/or occupational therapist. They’ll also help you develop a plan to cope at work when your condition flares.

Evaluate your workspace. Whatever your setting – office, retail, manufacturing, hospitality, transport – there are options for making it more supportive for you. The first step is to talk with an occupational therapist about the issues you’re facing and develop strategies to help you manage them. They may include simple things such as being aware of your posture throughout the day and changing position regularly to reduce pain, strain and fatigue. They may also involve changing your workspace to make it work for you.

For example:

  • using a standing/sitting desk
  • rearranging the setup so that items you use most often are close by
  • sitting on a chair or perch instead of standing for long periods
  • using a headset on your phone
  • getting lumbar supports for your chair or car seat
  • using a trolley to help you move heavy items.

Some of these options may be easy to do without going through your employer, but some changes may need their involvement. If your employer knows about your condition, then you can discuss these changes together. However if you’ve chosen not to disclose your condition, your employer is still obliged to make reasonable adjustments to your workstation or environment to ensure your comfort and safety. Things such as stand up desks, foot rests, wrist rests, height adjustable chair, ergonomic chair are all considered reasonable. For more information read our information on Employment FAQs and visit Safe Work Australia.

Take control of your pain. Chronic pain can affect your ability to do the things you want and need to do, your sleep quality, your concentration, and mood. Basically it sucks. That’s why you need a toolbox of strategies for managing your pain. There’s no one size fits all when it comes to pain management. So having several strategies you know work for you, is essential. They may include gentle exercise, medications, heat and cold, stretches, massage, splints, braces and aids and equipment. It’ll take some trial and error, but it’s well worth the effort to find what works best for you. You can then pull them out of your toolbox when needed, giving you more control over your pain. Your doctor and physiotherapist can also give you tips for managing your pain while at work. For more information and practical tips for dealing with pain, read Managing your pain: An A-Z guide.

Along with pain, fatigue is a massive issue for people with musculoskeletal conditions. Fatigue is very different from just being a little tired. It’s overwhelming physical and mental tiredness that makes every activity a struggle. But there are things you can do to manage so that it has less impact on your life and your work. Find out how.

Acknowledge the unpredictability of your condition. It’s a fact that musculoskeletal conditions are unpredictable. You often won’t know you’re about to have a flare until one happens. Apart from increased pain, stiffness, and fatigue, having a flare can be really stressful as you worry about getting things done – at work and at home. Having a plan in place for managing – before a flare occurs – means you can be proactive. This may involve developing a plan with your healthcare team that will help you cope at work, prioritising and pacing your activities so that you get any important, time-dependent tasks done when you’re feeling your best, discussing flexible work arrangements (like working from home) with your employer, or taking time off work or reducing your hours until you can get the flare under control. The important thing is that you’re prepared, with a plan of attack in place, ready to go when needed.

Use your scheduled breaks. It’s easy when you’re feeling under pressure – whether it’s from your employer or pressure you’ve put on yourself – to ignore your lunch or tea breaks and just keep working. But this will only add to your stress, pain and fatigue. You need to take some downtime during your day to eat, drink and give your mind and body a break. If you can, get outdoors and breathe in some fresh air. When you return from your break you’ll feel better, have a clearer head, and be more productive.

For more info and tips check out part 2 of this blog.

Call our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our team. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

Watch our webinar

Watch the recording of our webinar from March 2021, as Jessica Dawson-Field, Employment Associate, Maurice Blackburn Lawyers, takes us through employment law – rights and entitlements.

More to Explore

JobsAccess
Australian Government
JobAccess is the national hub for workplace and employment information for people with disability, employers, and service providers. It provides:

  • a wide range of info and services to help people with disability find and keep jobs, get promoted to better jobs, upgrade or expand their workplace skills
  • advice on modifying your work area, talking about your disability, training for your co-workers, negotiating flexible work arrangements and returning to work
  • the Employment Assistance Fund (EAF) gives financial help to eligible people with disability and mental health conditions and employers to buy work-related modifications, equipment, Auslan services and workplace assistance and support services.
  • and much more.

Work Assist
Australian Government
Work Assist can help you stay in work if you risk losing your job through illness, injury or disability.

I have a job and arthritis: Now what?
Arthritis Society Canada

Fatigue: Beyond tiredness
National Rheumatoid Arthritis Society (UK)

Sleep and pain
painHEALTH 

Managing flares
National Rheumatoid Arthritis Society (UK) 


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15/Feb/2024

Living with a chronic musculoskeletal condition costs us physically, mentally and emotionally. But what many people don’t understand are the substantial financial costs associated with having chronic conditions. They’re expensive.

Healthcare costs

These are the most obvious. Medications, lots of trips to your doctor, your specialist/s, allied health professionals, tests, exercise classes, surgery, orthotics….they all add up. A lot!

People who don’t have a chronic condition may assume that a lot of this is covered by government subsidies, GP Management Plans, health insurance, the Pharmaceutical Benefits Scheme, with a little sprinkling of magical fairy dust to cover the rest. Depending on a person’s situation some of this may be covered. But much isn’t.

There’s significant cost in seeing allied health professionals such as physiotherapists, podiatrists, occupational therapists, hand therapists, dietitians and psychologists. While GP Management Plans assist with the cost, there’s mostly only five visits provided and these are used up very quickly. There may also be a gap payment over the Medicare Rebate. And there are also often considerable out of pocket expenses to see a specialist privately or longer waits when you see them publicly.

This can put a significant strain on a person’s finances.

Employment

Living with a chronic musculoskeletal condition is varied and episodic. That means you often don’t know how you’ll wake up. Your pain and stiffness may have been under control and manageable for some time, but then one day you wake up feeling crap. Your joints are swollen, it hurts to move, and you’re soooo exhausted. This makes it difficult to get up and move around, let alone get to work and put in a full day, as well as all the other things you have going on – family, friends, studying, chores, and a social life.

This may lead to time off work, and using up all your sick and personal leave. But if the situation (or workplace) becomes unmanageable it may result in someone having to permanently reduce their hours, change jobs, become unemployed or retire early.

Any of these things will obviously affect your everyday finances. However it can also affect your future finances as superannuation is impacted by reduced or lost income.

Wow. This became really depressing really quickly.

The good news is there are services to help you if you need to change careers, or need financial assistance while you re-evaluate what you can or can’t do. We’ve added a bunch of these to the More to Explore section below.

And while we know none of these services are perfect, they can provide you with many of the tools and resources to help you through this tough time.

Hidden costs

Lost employment and medical costs – check. They’re probably the most visible costs. But there are many hidden costs. We’ve listed just a few.

  • Home and car modifications – so that you can continue to do the things you want and need to do as easily and pain-free as possible you may need to make changes to your home and/or car. They may be simple and relatively inexpensive – e.g. adding a swivel seat to your car to help you get in and out, or more complicated and pricey – e.g. installing a chair lift to help you get up and down the stairs in your home. An occupational therapist can help you work out what modifications will assist you, and can also advise you of any available schemes or assistance programs you may be eligible for.
  • As well as changes to your home or car, you may also need to buy various gizmos and gadgets that: protect your joints (e.g. tap turners, pick-up reachers), help you manage your pain (e.g. heat packs) and generally make life a little easier (e.g ergonomic mouse for your computer, walking aids). Again these can range in price.
  • Getting out and about if you’re in pain, or dealing with serious brain fog, can be tricky if you don’t feel up to driving. It was only made worse with the COVID pandemic, when many of us felt vulnerable catching public transport. So you may have resorted to catching a taxi or using a rideshare company. But over time this does add up. You may be eligible for a taxi subsidy – each state/territory has their own scheme – so it’s worth checking to see if you can access this.
  • Food, glorious food. Let’s face it there are many times you feel flattened by your condition and cooking is the last thing you want to do. And now with the convenience of delivery apps, you can get almost anything delivered to your door. Unless like me you live in an outer suburb in which case it’s fish n’ chips, pizza or burgers – yum, but not the healthiest options. These deliveries can be a lifesaver, but the cost can also very quickly add up.
  • Events and holidays. This’s a tough one. Because of the nature of chronic conditions and often not knowing how you’ll feel from day to day, you can pay for future events and then have to cancel or change at the last minute. Like tickets to a concert – you often buy them so far in advance and you’re excited for literally months! And then the night comes and you know you can’t go – you’re too tired, too sore, too whatever. So you have to forfeit your ticket, or give it away to a friend. Or you’re on holiday, but you end up having to pay to make changes because you’ve had a flare and you need an earlier flight home, or you need to catch more taxis than you’d planned to, or you need to buy a pillow because the one at your hotel is a rock. It’s the crazy, unpredictable stuff like this that’s hard to plan for and adds to financial stress.

 

Contact our free national Help Line

If you have questions about your musculoskeletal condition, treatment options, telehealthmanaging your pain or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


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12/Dec/2023

Our child has seen so many specialists and now they have been told to go to a kid’s physio. Are you thinking how will a physio help? Or how will this be any different to any other appointments we have? What do I tell my child they will be doing with them?

I am Nicole Pates, a Titled Paediatric Physiotherapist and director of Western Kids Health, a paediatric clinic in Perth Western Australia. I have been a Paediatric physio for over 13 years and these are the things I would like you to know about seeing a paediatric physio.

Children and teenagers, as we all know, are different from adults. Not just physically, but in all of their systems. Their brain is growing and their understanding of their body and how it works is constantly changing. Add into that school, friends and puberty and well, it can be a lot. Let alone managing chronic pain and fatigue on top of this. This is why it is important to work together with a physiotherapist who is experienced in working with kids and teens, who understands growth and development. You can search for a Titled or Specialist Paediatric Physiotherapist, who has undertaken extra study or experience in paediatrics, on the Australian Physio website https://choose.physio/find-a-physio

For families of children with persistent pain and / or fatigue, finding the right help can be tricky.  You can find a practitioner experienced in working in paediatric pain on the Australian Pain Society website  https://www.apsoc.org.au/Home/wcontent2/60

Once you have chosen a physiotherapist you will be *hopefully* be on your way to an appointment. You may be required to fill out some questionnaires or forms, prior to your initial appointment, depending on your reason for visiting the physiotherapist.

Typically, an initial appointment for children with chronic musculoskeletal / rheumatological conditions will be an hour or potentially more. For some families at Western Kids Health, we might sit down for 2 hours with not just physio but also OT and psychology. I encourage you to contact your chosen clinic to find out more about the first appointment. It is important to dress in clothes that are comfortable to move in and take a water bottle if needed.

Your physiotherapist may ask lots of questions in the first appointment. Not just about your child’s condition, symptoms, history, current team and limitations but also about their strengths, likes and future goals. Your physio will then watch how your child moves and plays, particularly the things they are having trouble with.

We love watching kids move and figuring out the different reasons as to why they might be having trouble or moving differently.

Being able to identify the activities that trigger your child’s symptoms, understanding their experience and watching how your child moves will enable your physio to work with you to formulate a plan. This plan should be collaborative and based around your child’s goals such as getting back to school, sport or hobbies. Having pain or fatigue can be so annoying and make moving and doing things difficult. But with chronic conditions, waiting for the pain or fatigue to go away before you get back into things can be an endless waiting game. Your physio will help you get back into doing things in a way that is meaningful, fun and supported.

Your physio may also provide education around:

  • Symptoms such as pain and fatigue and potential triggers / aggravators
  • Strategies on how to bring awareness to and strategies to minimise triggers and aggravators
  • Why your child may be experiencing pain.
  • How best support your child and their pain journey through supportive language in a progressive mindset

Your physio will also work hard to understand where your child’s physical function is at present and work out a plan to build on their activity level, strength, balance, movement control and most importantly, function over time. Your physio will support your child (and you!) with a plan for flare ups or set backs.

Other team members who your physio may recommend supporting you are

  • An Occupational Therapist, who assists your child to minimise the impact symptoms may have on sleep, school and relationships
  • A Dietician to understand your child’s nutrition needs whilst they are growing and create plans to support and meet these needs
  • A Psychologist to build coping skills and resilience and manage mental health symptoms such as low mood, stress or anxiety. This is important as often these symptoms are contributing to or exacerbating your child’s ability to engage in the physical rehab.

At Western Kids Health we run specialised groups in conjunction with the Arthritis & Osteoporosis Association of WA, including group hydrotherapy and strength and conditioning classes.

Hydrotherapy and physical conditioning for children with conditions like Juvenile Idiopathic Arthritis is safe and effective. Building strength through range is essential to keep your joints healthy. Your physio will work with you to help your child understand their body’s reactions and sensations as they try new activities. This will help your child build their capacity and understanding of body awareness. Your physio will help explore what movements and types of exercise work best for your child’s body, and most importantly making it fun!

You should see improvements over time with the right support and if you aren’t seeing those improvements, or your child isn’t reaching their goals, please discuss this with your therapy team.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


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04/Oct/2023

If you’ve been experiencing persistent joint or muscle pain, stiffness and/or inflammation that you can’t explain (e.g. from a fall or strenuous physical activity), you should discuss your symptoms with your general practitioner (GP).

Many conditions can cause these symptoms, so to work out what’s causing your symptoms, your GP will:

  • Take your medical history. They’ll ask you about your symptoms, when they started, how they affect you, your family medical history and other health issues you may have.
  • Do a physical examination. They’ll look for redness and swelling in and around the joint and test your joint’s range of movement. They may also look for rashes, check your eyes and throat, and take your temperature.
  • Order scans and other tests. Depending on the condition your GP thinks you might have, they may send you for tests to check for levels of inflammation in your blood or specific genetic markers. You may also have scans such as x-rays, ultrasound or CT (computed tomography) to get a clearer picture of what’s happening inside your body.

When your GP has gathered all of this information, they may refer you to a rheumatologist.

Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system. You need a referral from your GP to see a rheumatologist, whether they’re in private practice or a public hospital outpatient clinic.

Your GP may refer you to a rheumatologist if:

  • they think you have, or they’ve diagnosed you with, an inflammatory type of arthritis such as rheumatoid arthritis or ankylosing spondylitis, so that treatment can be started as soon as possible
  • your symptoms improve with treatment but come back when you stop taking medicine
  • your symptoms don’t respond to treatment or get worse over time
  • you develop unexpected complications, such as a fever, rash, or fatigue
  • you have unusual test results.

Preparing for your first consultation

When you make an appointment to see a rheumatologist, you should ask them some questions so that you’re prepared. This may include:

  • What do I need to bring with me?
  • How much will my out-of-pocket expenses be?
  • How long will my appointment be?
  • Is there parking available, or accessible public transport?

Armed with this information, you can be proactive and prepare for your consultation.

It can be helpful to make notes about your symptoms – when you first noticed they appeared, how they affect you day-to-day – as well as other health conditions you have, medicines or supplements you take regularly and information about your family medical history.

It’s also helpful to write down questions you want to ask your rheumatologist. Put them in order of the most important first, in case you don’t get through your entire list.

Your consultation

Seeing a specialist can sometimes be overwhelming, especially if you’re feeling unwell or anxious. There can also be a lot of information to absorb. That’s why it can be helpful to bring a family member or a friend to your appointment. They can provide emotional support, help you ask questions or write down any important information. They can also be a second set of ears to hear what the specialist says and help you recall this information later. It can be hard to remember everything, especially when you’re feeling anxious.

Wear comfortable clothing that can be easily adjusted or removed if necessary, so that the rheumatologist can examine you.

And don’t forget your referral, x-rays, scans and other test results, your list of questions and any other bits and pieces you were asked to bring!

Your first consultation with your rheumatologist will be more thorough than your consultation with your GP. They’ll:

  • review your medical history
  • ask lots of questions about your symptoms, such as when you’re most stiff or sore, and how long you’ve had pain and symptoms
  • do a comprehensive examination of your joints, including counting the number of tender and swollen joints
  • refer you for further blood tests and imaging if required.

It’s important to know that there are many different types of musculoskeletal conditions, and many have similar symptoms. So it can take time to get a diagnosis. Your rheumatologist may provide you with a prescription for medicines and suggest some self-care options that you can do while you wait for your diagnosis.

Follow-up consultations

Once your diagnosis has been made, your rheumatologist will provide you with information about your condition and a treatment plan.

Your treatment plan will fit your specific symptoms, needs and preferences. However, it will usually involve a combination of:

Depending on your diagnosis, you may need regular consultations with your rheumatologist.

How often they occur will depend on your condition, how well it’s responding to treatment and the medicines you’re taking, as some specialised medicines can only be prescribed by a rheumatologist. Some people see a rheumatologist regularly, while others are mainly treated by their GP, with the rheumatologist on hand for specialist advice. Some consultations with a rheumatologist may be done via telehealth.

Follow-up consultations are generally shorter than your initial one. Your rheumatologist will talk with you about how you’ve been doing since you began treatment. They’ll assess how well you’re responding to treatment and if you need to change your medicines or add additional ones. They’ll also do a physical exam and order any further blood tests or imaging if required.

Your rheumatologist will also talk with you about your self-care and other things you can do to manage your condition.

It’s important to take an active role in these consultations. Ask questions, and if you don’t understand the answers, ask them to explain further or for more information. Talk with your rheumatologist about your goals for treatment – they may be things like reducing pain and fatigue, but also more personal goals such as getting back to playing golf regularly or planning an overseas trip. Together you can ensure your treatment plan supports your goals.

Ongoing care

The aim of treatment for musculoskeletal conditions is low or no disease activity. This is called remission. It doesn’t mean your condition has been cured, but your treatments keep it under control.

With the significant advancements we’ve had in medicines in the past few decades and targeted treatments for many types of musculoskeletal conditions, achieving remission can be a real possibility.

If you achieve remission, your rheumatologist may reduce the dosage and/or frequency of the medicines you’re taking. They’ll monitor you to see how you’re doing and make changes as required. And you won’t need to see them as often.

If you haven’t achieved remission, the aim will be to control your condition and its effects on your body and life as much as possible. This will determine how often you need to see your rheumatologist in the future.

Costs

The cost to see a rheumatologist varies. Part of the cost is subsidised by Medicare, but there is usually a gap payment that you’ll need to make. When making an appointment, ask about out-of-pocket costs.

If you have a Medicare card, you may be able to attend a rheumatology clinic at a public hospital if you cannot afford out-of-pocket expenses to see a rheumatologist privately. Talk with your GP about your options.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

 

First written and published by Lisa Bywaters in May, 2022.


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Chronic (or persistent) pain is a common and complex problem affecting 1 in 5 Australians aged 45 and over.(1)

Dealing with chronic pain can be challenging. But there are many things you can do and resources available to help you manage. The first step starts with seeing your doctor.

Here are five reasons you should see your doctor about your pain.

1. You want to take control

Talk with your doctor about pain management programs if you want to learn about managing your pain more effectively. These programs are available in person and online.

Pain management programs aim to reduce the impact that pain has on your life. They treat you as a whole person and don’t focus solely on your pain. That means they address everything from exercise to mood, stress, goal setting, sleep, managing your activities, returning to work, and more.

By attending a pain management program, you’ll learn from doctors, physiotherapists, occupational therapists, nurses, and psychologists. They’ll provide information, advice and support to help you take control of your pain.

Talk with your doctor about whether a pain management program would be helpful.

2. You’re not coping with your pain

It’s important to talk with your doctor if you feel like you’re not coping, especially if:

  • you’re taking more of your medicines than prescribed
  • you’re mixing your medicines with other drugs, including alcohol
  • you’re drinking excessive amounts of alcohol
  • you’re having problems sleeping due to pain
  • you’ve been feeling very low for more than a few weeks
  • you’ve been missing work because of pain
  • you’re more worried, frustrated and irritable than usual.

Your doctor understands that living with pain is difficult. They can work with you to find the right pathway to help. They can also refer you to other health professionals, including physical and/or mental health specialists.

3. You’re struggling at work

If you’re not coping with your work responsibilities or just getting to and from work has become difficult because of your pain, discuss this with your doctor.

Evidence shows that working improves general health and wellbeing for most people and reduces psychological distress.

That’s why finding ways to stay at work, even with chronic pain, is important. Your doctor can give you information and support to do this. They can also refer you to other healthcare professionals – e.g. physiotherapists, occupational therapists and specialist doctors (occupational physicians) – to help you stay at work.

And check out our resource WorkWise for info and tips to help you at work.

4. You’ve decided to stop taking your regular medicine for pain

You should talk openly with your doctor if you’re considering stopping any medicines. Some may need to be reduced gradually to avoid potential side effects. Your doctor will advise you on this.

5. You’ve noticed significant changes to your symptoms

It’s also important to be aware of other health changes that may occur. They can appear for various reasons, many unrelated to your pain.

However, if you’ve been experiencing any of the following symptoms, talk with your doctor:

  • a sudden increase in the intensity of your pain
  • sudden loss of muscle power in your legs or arms
  • sudden change in your ability to empty or control your bladder or bowel
  • a lack of sensation anywhere in your body
  • sudden onset of pins and needles or numbness in either hands or feet
  • sudden onset of poor balance or a lack of coordination
  • unexplained and ongoing loss of weight
  • sweats at night time
  • moderate or severe pain at night or at rest
  • new pain in your abdomen, chest or head which doesn’t go away.

These ‘red flags’ tell your doctor that something has changed. Changes in pain and other signs and symptoms are treated with caution. Your doctor will investigate potential causes to understand what’s happening and how/if to treat it.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

Reference

(1) Chronic pain in Australia, Australian Institute of Health and Welfare, 2020.


hand-therapy.jpg
10/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

A surgeon once told me that the human body’s most elegant anatomy was in the hand. I might be slightly biased, but I had to agree! The hand is amazing and complex in the way it’s structured and works.

There are 27 bones in your hand compared with just 3 in your leg. These bones are moved by over 30 muscles, all working in unison to provide smooth, coordinated movements. Your nerves help you control these movements enabling you to adjust your strength or fine coordination to suit the task.

Your hands can convey your feelings through touch and gesture and help to communicate your thoughts. In fact, some people will tell you they can’t talk without using their hands!

Your wrists, elbows and shoulders work together to position your hands in space. Any problem along the chain of your upper limbs affects your ability to fully function. Imagine how difficult it would be to reach up to do your hair if your shoulder was stiff, or to do downward dog in yoga with a painful wrist!

We connect with the world through our hands, performing everyday activities, and many of us earn our living with our hands. That’s why it’s essential that we take good care of our hands.

For some people, this may include seeing a professional.

What is hand therapy?

Considering the importance of our hands, it should be no surprise that there are professionals devoted solely to their rehabilitation.

Hand surgeons are either orthopaedic or plastic surgeons who’ve undergone additional training and study to specialise in treating problems of the hands, wrists and arms. They may use surgical and/or non-surgical treatments.

Hand therapy practitioners are qualified physiotherapists or occupational therapists registered with the Allied Health Practitioner Regulation Agency (AHPRA). They have extensive knowledge and skill in understanding and treating problems with the fingers, wrists, elbows and shoulders. The Australian Hand Therapy Association (AHTA) defines hand therapy as “the art and science of rehabilitation of the upper limb – shoulder to fingertip”.

What is an Accredited Hand Therapist (AHT)?

In 2017, the Australian Hand Therapy Association implemented a credentialing program to ensure accredited therapists offer a high standard of practice. All Accredited Hand Therapists have undertaken advanced education and assessment of the upper limb and have had over 3,600 hours of hand therapy clinical practice. After they’re assessed as competent to provide safe, evidence-based diagnosis, advice, and treatment, they’re awarded the credential of Accredited Hand Therapist by the Australian Hand Therapy Association Credentialing Council.

What conditions are treated?

Accredited Hand Therapists diagnose and treat a large variety of musculoskeletal conditions of the upper limb. They include:

  • arthritis
  • nerve compressions (e.g. carpal tunnel syndrome)
  • fractures, joint injuries and dislocations
  • tendinopathies (e.g. tennis elbow) and other soft tissue injuries
  • pain conditions
  • nerve and tendon injuries
  • burns and scar management
  • sporting injuries
  • work-related injuries
  • post-surgical conditions.

What happens at an appointment?

When you meet with an Accredited Hand Therapist, you’ll work together to develop a treatment plan. It will take into consideration your specific situation, symptoms, and the environment in which you live and work.

Some treatments aim to resolve a problem, for example, improving muscle strength or range of motion after a fracture. Some treatments may be preventive and involve teaching you to manage symptoms like pain or swelling in response to an injury or illness.

Assessments may involve specific measurements; for example, the therapist measures your wrist’s range of movement or grip strength. Assessments also include your experience of the problem, for example, when you describe the location of the problem, how your symptoms feel and affect you, and the things you noticed or experienced when you first noticed your symptoms.

Treatments often use heat, ice or electrotherapy to improve healing, orthoses (splints) to rest soft tissues (e.g. muscles, tendons, ligaments), and specifically targeted exercises to improve movement and strength.

You’ll be encouraged to complete a home program when possible, so education will also be a large part of your treatment.

To achieve the best outcomes, therapists may collaborate with other health professionals such as hand surgeons, rehabilitation consultants or GPs.

Where do I find an Accredited Hand Therapist?

Accredited Hand Therapists can be found throughout Australia in private practice (sometimes co-located with hand surgeons), in public hospitals and in community settings. In Australia, there are over 400 Accredited Hand Therapists in metropolitan, rural and remote locations. You can contact a hand therapist through the AHTA “Find an Accredited Hand therapist” web page or email the AHTA at enquire@ahta.com.au.

You use your hands all day long, so receiving the best care to recover after surgery, injury, or a medical condition is essential. Your hands deserve the best, and so do you!

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.


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25/May/2022

In March 2020, at the beginning of the pandemic, the Federal Government made telehealth available for all Australians. This enabled us to access our general practitioner (GP) and other healthcare providers from the comfort – and safety – of our homes.

As of 1 January 2022, many telehealth services became a permanent and ongoing part of Medicare.

Eligible patients will continue to have access to GP, specialist, nursing, mental health care, midwifery and allied health services via telehealth where the healthcare provider believes it’s appropriate.

It’s important to note that telehealth consultations will not take the place of face-to-face consultations. They’re just another option that may be convenient, and yet another example of the hybrid world we now live in 😉.

What is telehealth?

Simply put, telehealth enables you to consult with your healthcare provider over the phone or through a video platform (e.g. Zoom, Skype, FaceTime). Your healthcare provider may specify which platform you need to use.

Depending on your available technology and how comfortable you are using it, you might have a conversation over your phone with your doctor (like any other phone call), or interact face-to-face via the video platform.

If you’re only comfortable talking on your phone, that’s ok. You don’t have to download apps and learn how to use them, especially if this makes you anxious. You can choose to see your healthcare provider in person or consult over the phone if appropriate.

But if you’re interested, video platforms are easy to use. And they allow your healthcare provider to see you and assess you visually. This obviously gives them a lot more information about you and your health. The platforms and technology just take a little practice 😊.

However, a change that did come into place in January 2022 means that for initial and complex specialist consultations, face-to-face and video services are required. Telephone consultations are only available for subsequent and minor consultations. This is because you and your specialist will have a better quality consultation face-to-face or via video than you could over the phone. This is essential for your first consultation or if your situation is complex and can’t be managed effectively and safely over the phone.

Why would I choose telehealth over face-to-face consultations?

You may choose telehealth over face-to-face consultations if you’re feeling unwell or fatigued, and going in person would make you feel worse. Or, you may not be able to take time off work to go to an appointment, but you do have a quiet space at work where you can have a private telehealth consultation during a break. Or, you may live in regional or remote parts of the country and accessing a healthcare provider via telehealth is more convenient and timely.

It’s also your only option if you have COVID and you’re self-isolating. We still need to restrict the spread of the virus.

And remember, it’s not an either/or situation. Face-to-face and telehealth consultations will continue alongside each other – with both having their merits.

What are the costs?

During the initial phase of the COVID telehealth rollout, all telehealth consultations were bulk-billed. This was to keep us at home and reduce the spread of the virus.

However, with most of the population now vaccinated and living in ‘COVID-normal’ times, you can’t assume that telehealth consultations will be bulk-billed. So when you’re making your appointment, ask if it will be bulk-billed or if you have to pay a consultation fee.

The video platforms are free to download and use.

Eligibility

As with the rules when telehealth was first introduced in 2020, you still need to have an existing relationship with your GP to meet eligibility requirements. That means you must have had a face-to-face consultation with the same GP or another practitioner at the same practice in the 12-months before a telehealth consultation.

It’s not always easy

As many of us have discovered over the last couple of years, as we’ve been working, schooling and just trying to entertain ourselves at home, there are always teething issues. The two biggest issues are technology and time.

Technology – it can make our lives easier and more entertaining, but sometimes it seems like it just makes things more complicated. Like when you’re tired, anxious, frustrated, unwell or in pain, everything, including technology, seems against you, and nothing seems to work 😑. Often this is because we find it difficult to focus or concentrate; after all, we’re tired, anxious, frustrated, unwell or in pain. Other times it may be because there’s a big demand on the system. Everyone is trying to get online for one reason or another, which may cause slower internet speeds.

Time – as with any appointment, there can be issues with time. Your healthcare provider may be running late because of tech issues, other patients have needed more time, there’s been a medical emergency, or because they’re human and have lives and families too, and things can get in the way. Or you may be running late for similar reasons. We all need to be patient and give people a little leeway as we navigate this new ‘normal’ we find ourselves in.

But we can make it easier

We’ve identified these potential issues not to freak you out but to prepare you. Honestly, they may not happen at all. But there are things you can do to prepare for your telehealth consultation that will make things easier for everyone.

Be patient – if your doctor is running late, if your internet is slow, if your appointment is rescheduled due to an emergency, be patient. This can be hard to do when you’re unwell or in pain. But becoming impatient won’t change the situation and will only make you feel worse – physically and emotionally. Make a cuppa, read a book, do a crossword puzzle, talk with your partner/cat/dog/kids – distract yourself while you wait.

However, if you have chest pain, difficulty breathing, or a medical emergency, call 000 immediately. Don’t wait for your telehealth appointment.

Be prepared – before your appointment, make a list of the things you want to discuss with your doctor. Put them in order from the most important to the least. That way, you won’t finish your consultation and then kick yourself for not asking X. Also – be aware that your appointment may end earlier than you anticipate if there’s a tech issue or an emergency. So lead with your most pressing questions or concerns, and if you have time, follow with the less important ones.

Be kind – Our healthcare providers are doing the best they can, often under stressful, trying circumstances. During this crisis, they’re our frontline, so please be kind to them. And be kind to yourself. You’re learning new technology or new ways to do things and just trying to stay sane during an insane time – recognise that you’re also doing the best you can. So hang in there.

Talk with someone who cares

Call the National MSK Help Line – our nurses are available weekdays from 9am to 5pm on 1800 263 265, or you can email helpline@msk.org.au. They can help you with info and support about musculoskeletal conditions, managing pain, treatments, accessing services, and much more.

More to explore


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09/Dec/2021

Did you know that 52% of Australians are putting off their healthcare due to concerns about COVID-19? (1)

This alarming figure has prompted the Continuity of Care Collaboration (CCC), a network of more than 35 peak bodies, industry and healthcare organisations, to create the #DontWaitMate campaign.

The campaign aims to reassure people that attending their GP, dentist, pharmacist, allied health professionals, and specialists is safe. That it’s safe to get blood tests, skin tests, scans and all other pathology tests.

It’s essential that anyone with chronic or complex health conditions, the elderly, vulnerable communities and people who are immunocompromised have continuity of care so that they’re able to live as well as possible. And that any changes in their health are picked up as soon as possible.

#DontWaitMate campaign also urges anyone who’s been putting off their tests or has noticed urgent and/or new symptoms to pick up the phone and make an appointment today.

Your health is the priority.

CCC explains that there are measures to help you feel safe to access health care needs remotely, e.g. through telehealth, e-prescribing of medicines and home delivery of medicines. If you need to go to a clinic or hospital, personal protective equipment, regular cleaning, and distancing measures are all in place.(2)

It’s all about keeping you safe while managing your ongoing healthcare.

So Don’t Wait Mate. If you’re like me and have a pathology form stuck on the side of your fridge or a poo test in your bathroom drawer, go and get it, pick up the phone, and make that call. Don’t let them expire like I did ?. It just adds to the time you’re waiting to ensure everything’s ok.

Or, if you’ve noticed some changes in your health or body that concern you, make an appointment with your doctor to discuss them.

Because your health is too important to neglect.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

Reference

(1-2) Continuity of Care Collaboration
https://continuityofcare.org/


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