Most of us have very poor understanding of what is high value pain management. When I present data or evidence on how should a person’s treatment look, most chronic pain patients tell me that nobody has ever told them before.

You may find it strange that my latest blog posts have  been focused on the softer modalities such as mindfulness practice and gratitude journaling. Some of you may even find them fluffy.

Fortunately for us, we have reasonably robust evidence to suggest that they may help.

In this series, I want to discuss how does a high value, holistic chronic pain management look like for you.


#1: Person-centred care

nasi padang, telok ayer, indonesian food
One of my clients sent a surprise lunch from Pagi Sore over the circuit breaker period. I am completely grateful for the kindness and 100% enjoyed the food.

You probably wouldn’t like it if the staff at a cai png or nasi padang stall picked your dishes for you.

Sure, they know you are hungry. They also know they can solve your problem by providing you with food.

What if they did exactly that?

Are you going to enjoy the dishes they chose for you though?

Most probably not.

Like it is unreasonable to expect the kind macik to pick out your favourite food, it’s impossible for chiropractors or physiotherapists to know what is important to you without asking you first.

You may be thinking that you want to be free from back pain and surely the chiropractor already knows that.

Do they though?

Do you want to sit at the computer without back pain or do you want to play tennis without back pain? While you may experience lower back ache with both activities, which is more important to you?

You see, these are dramatically different goals that require different management strategies. Just because I can make your pain go away right now doesn’t mean it won’t come back tomorrow when you return to your office.

Just because you can sit at the computer pain-free for the whole day, doesn’t you can go back to playing tennis pain-free and vice versa.

That is not to say you cannot achieve both.

The big question remains: Why are you here?

Virtually every chiropractor and physiotherapist would ask that question.

The problem is that most of them are willing to take very poorly answered replies.

If you have been living with chronic pain and your previous treatments didn’t work out, have a think about it.

Did anyone ask what you want to get out of treatment?

There are at least two other important questions that most healthcare providers don’t seem to ask:

  • What do you think is going on/giving you your symptoms?
  • What do you think needs to happen for you to recover?

Maybe you are thinking it’s our jobs to answer these questions.

You are right.

It is also our jobs to make sure you understand what is going on so we can lead you to the results you are after.

How does that sound?

Let’s talk using a condom

condom use, education, error

Believe it or not, the top questions asked on Google relating to condom are:

  • How to use a condom?
  • How wear a condom?
  • How to put on a condom?

That sounds good right? People are looking into condom use so they can use it correctly.

We know that condoms have a high success rate when it comes to preventing sexually transmitted diseases as well as unwanted pregnancies. The only condition is that people have to use it right. Sounds fair?

A study looked at condom use errors around the world and the results may surprise you:

  • Up to 11% of users opened the condom pack with a sharp object
  • Up to 30% of users would put on a condom the wrong way (inside out) then flip it over and reuse the same condom!
  • Almost 50% would fail to squeeze air out of a condom before intercourse or fail to leave some space at the tip for semen collection

My point is simple, it’s not enough that your chiropractor or physiotherapist knows what is going on with you and just give you the treatment that works.

You also need to be an involved participant

Ellen Langer, the first female professor to be tenured in psychology at Harvard, said in an interview:

“I try to make clear at the beginning that if something happened to me I would go to a physician. However, that’s where the similarity between me and what I see as many people would end. You don’t turn yourself over to somebody else because you’re the keeper of all the information — they don’t have all the idiosyncratic information. At the very least we should be partners in our health care.

Interviewer: “And is that a mindful approach, while a mindless approach would be to go in and say, “Doctor, this hurts, do your thing,” and then sort of tune out?”

E.L.”Yes, and what the doctors may be doing mindlessly is using probabilistic information, data, as absolutes. There’s no study, no matter what the area — physics, psychology, biology, it doesn’t matter — that yields more than a probability.”

A lot of chiropractors and physiotherapists may prefer that you be a mindless patient. That is you come in, tell them what hurts, ask zero questions, pay up, and leave.

That works excellent especially when we are short of time. It also means we can see more clients per hour. It’s really a winning arrangement for us.

But what about you?  Is this a win for you?

No, it isn’t.

This is why I choose to adopt a bio-psycho-social approach at my practice.

I am committed not only to help you find freedom from pain but also to make sure you can get back to what is important to you. Be it returning to your Tuesday night salsa or increasing work productivity, I am the chiropractor who wants to see you get there.

In fact, I want to do better. I founded Square One Active Recovery to help people find long-term pain solutions. I work hard to make myself redundant to my clients.

Person-centred values in healthcare

The eight values in person-centred healthcare are individuality, rights, privacy, choice, independence, dignity, respect, and partnership.

All that you need is a healthcare professional who, at the very least, ask three questions:

  • Why are you here?
  • What do you think is going on/giving you your symptoms?
  • What do you think needs to happen for you to recover?

By asking these questions we have addressed:

Individuality and respect: what you want as a patient is unique to you. I also respect that you have your own priorities, understanding of your symptoms, and expectations of how recovery should look.

Choice: by engaging you with these three questions, I am able to provide you with the accurate information necessary for you to make a decision on care. This is informed decision-making. You have a choice. Remember, what I have to say about your condition may be different from what you expect (we wouldn’t know if I didn’t ask). Without correctly understanding what is going on, you cannot make a decision that is truly informed.

Dignity and partnership: co-decision making – I choose to respect you as a person and a partner in co-constructing your pain solution. I value your individuality, ethical, and moral beliefs, and would work your recovery around them.


I hope in sharing this with you, you’d have a better idea of what to look for in choosing the right person to work with you for your chronic pain. Most of you reading this would probably have experienced subpar treatments with little to no results. I am sorry you had to undergo that experience.

In my subsequent posts, I will continue to discuss how does high value musculoskeletal care look.

Remember, don’t settle for an average chiropractor or physiotherapist!

If you are looking for a pain solution that doesn’t involve a 50-session chiropractic adjustment package, book in for an appointment with me to discover the difference the right care can make.

Your Recovery Journey Begins Now

Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, chiropractor Jesse Cai founded Square One Active Recovery to deliver recovery goals in just 12 weeks.

Not getting results from your chiropractor, TCM doctor or physiotherapist? Book an appointment to discover the difference the right care can make.

*We do not offer short-term pain solutions such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.

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