The Biopsychosocial Management of Complex Low Back Pain: A Stratified Care Approach

Presented by Gail Sowden

9/19/2018 – 9/23/2018

Concord Hospital Center for Health Promotion
Concord, NH

Course dates are September 19, 20, 22 and 23, 2018
7:30am - 3:30pm
Contact hours: 27

Price is $675

There are limited spots for this course.  If you would like to be placed on a waitlist after registration closes, please contact us at


Do you want to be better equipped to help patients manage their pain and distress?  

Are you interested in how to screen patients that may be at high risk for biopsychosocial involvement? 

Join NHAPTA, the University of Vermont Medical Center and Concord Hospital for a dynamic 4 day condensed program on biopsychosocial management of complex back pain taught by Gail Sowden from Keele University.  

This program is rarely available in the US and seats are limited. 

 We do have a room block (September 18 -23) at:

172 North Main Street · Concord, NH 03301
Phone: (603) 224-9534    Fax: (603) 224-8266

$129.00 Single/Double Occupancy / night {$10.00 per additional person}
Note:  The above rates are subject to a 9% NH State tax.

Please make your reservation by: August 18, 2018.  Refer to: NHAPTA / code: 16855


Course Overview: 

This 4 day interactive, skills based course is based on the STarT Back stratified care approach to the assessment and management of low back pain. 

The course provides a brief overview of the approach and how to manage the low and medium subgroups and then specifically focuses on equipping physiotherapists and physical therapists with the knowledge, skills and confidence to manage the distressed and disabled (high risk) subgroup of patients. 

Key care frameworks and models of pain will be covered as well as key factors that contribute to the development and maintenance of pain related disability. Assessment content includes a focus on the high risk patient, integrating the bio and the psychosocial and communication skills in practice.  Topics relate to managing the ‘high risk’ patient include dealing with stress, explaining pain, managing expectations, facilitating behavioral change, goal setting, sustaining and increasing activity, increasing meaningful living, managing challenging patients as well as clinical decision making and treatment planning.  

This course is aimed at practicing musculoskeletal out-patient physiotherapists and will be lead by Physiotherapist, Gail Sowden from Keele University Institutes for Primary Care and Health Sciences will lead the program.  

Detailed Content and Objectives 

Stratified care

  1. To understand the rationale for stratified care

The subgrouping tool(S)

  1. To understand the development and validation of the STaRTBack subgrouping tool
  2. To understand the STarTback Trial design and main results
  3. The IMPaCT Back study design and main results

The matched treatment pathways

  1. To understand the low risk, medium risk and high risk matched treatment pathways.

Models and pain

  1. To understand the limitations of the biomedical ‘model’, the psychogenic ‘model’ and the motivational ‘model’.
  2. To have an understanding of the biopsychosocial framework.

Pain and the neuromatrix

  1. To understand the neuromatrix
  2. To have a basic understanding of peripheral and central sensitisation, modulation and cortical re-organisation.

Pain is an output

  1. To understand that pain is an output.

2. To understand that there are other inputs and outputs relating to pain.

Cognitions and emotions

  1. To have a basic understand of a key psychological risk factors and to be able to recognise them.
  2. To understand what pain related beliefs are, their significance and examples of the most important ones.
  3. To understand catastrophising and to be able to recognise it.
  4. To understand the role of clinicians’ beliefs


  1. To understand that the normal response to pain is avoidance
  2. To understand pain behavior
  3. To have a brief introduction to operant conditioning
  4. To understand the importance of social context
  5. To understand solicitousness
  6. To understand social/observational learning.

Communication Skills

  1. To understand the importance of effective communication
  2. To be able to facilitate behavioural change (motivational interviewing).
  3. To be aware of strategies that can discourage assessment of the patient’s perspective.
  4. To be able to identify obstacles to effective communication.
  5. To understand the importance of active listening, validation and empathy.
  6. To be able to build rapport and identify the patient’s expectations and objectives from the consultation.
  7. To be able to co-create the agenda
  8. To be able to facilitate patient responses and develop an accurate understanding

Assessment of the high risk population

  1. To understand yellow flags.
  2. To be aware of some of the wider issues that can contribute to the development or maintenance of pain-related disability
  3. To be able to identify yellow flags.
  4. To be able to elicit yellow flags.
  5. To be able to integrate the bio and the psychosocial assessment

Dealing with distress

  1. To explore different ways of managing distressed patients.
  2. To consider whether it is possible to differentiate between pain-related distress and non-pain related distress.
  3. To understand that distress can be as an obstacle to progress or an orange flag.
  4. To consider what you can manage (and how) and what you can’t and how to access appropriate services for the patient.
  5. To consider what to do when patients have co-existing mental and physical health problems.

Shifting the agenda

  1. To understand the purpose of treatment and the importance of the patient having a shared understanding of this.
  2. To be able to shift the agenda from pain control/reduction to living a good life, with pain

Explaining Pain

  1. To explore the potential pros and cons of a diagnosis
  2. To be aware of the different ways of trying to change cognitions.
  3. To be able to understand some of the general principles of giving an explanation.
  4. To be able to explain pain

Managing Expectations

  1. To understand some of the key considerations regarding investigations, invasive procedures and non-evidence based treatments.
  2. To be able to manage patient’s requests and expectations (e.g. regarding non evidence based treatments, investigations, invasive procedures etc.).
  3. To be able to help patients make sense of multiple diagnoses and advice.

Facilitating behavioural change

  1. To be able to facilitate behavioural change (motivational interviewing).

Goal setting

  1. To understand the importance of goal setting.
  2. To understand the process of values based goal setting and monitoring.
  3. To be able to facilitate a patient in goal setting

Sustaining and increasing activity

  1. To be aware of the pacing controversy
  2. To understand the principles and practice of pacing and graded activity
  3. To be able to help patients maintain or alter activity levels e.g. through principles and practice of graded activity and to understand that this may engender rule governed behaviour.

Behavioural Theory and Practice

  1. To understand behavioural theory and practice

Increasing meaningful living

  1. To understand that it’s not necessarily about helping people to do more, it’s about helping them to do more values based activities (do more, do less, do different).
  2. To understand an alternative, more flexible, less rule governed alternative to traditional graded activity which is about increasing meaningful living.
  3. To be able to explore and raise patients awareness of their current behaviour and it’s workability for values
  4. To be able to emphasise the purpose of behaviour change
  5. To be able to foster Willingness
  6. To be able to create opportunities for exposure to avoided, values based activities.
  7. To understand the importance of reviewing progress and rewarding effort not just effect
  8. To be able to enhance generalisability.

Clinical decision making and treatment planning

  1. To be able to make sense of the assessment findings
  2. To be able to identify modifiable and non -modifiable risk factors (obstacles versus show stoppers).
  3. To be able to distinguishing pain related distress from other causes of distress.
  4. To be able to determine the relative severity / importance of each risk factor in an individual.
  5. To be able to clinically reason  (to treat, to refer or not to treat)

Monitoring and modifying treatment

  1. To be able to modify treatment as necessary.
  2. To know when to discharge a patient.

Managing challenging patients

  1. To be able to apply the CBT cycle to your own behaviour.
  2. To be able to set up a different clinician’ and patient’ experiences.


  1. To understand the steps to successful implementation, be aware of key innovations and how to implement them.

Ms. Sowden (BSc) is Consultant Physiotherapist and Allied Health Professional lead for pain rehabilitation across the largest National Health Service trust in the UK.  She provides clinical input and leadership to an award winning interdisciplinary pain service and has led service redesign projects resulting in new services and job roles. She also works as a Research Fellow in a clinical trials unit (Institute for Primary Care and Health Sciences, Keele University, UK) where she is involved in world leading musculoskeletal research (e.g., STarTBack, IMPacT Back, BEEP, SWAP trials), is a co-applicant on international research collaborations and publishes in peer reviewed journals (e.g. Lancet). She helped develop the matched treatment for the high risk subgroup of patients in the STaRTBack trial (Hill et al, 2011) and IMPaCT Back study (Foster et al, 2014) and delivered the psychologically informed physiotherapy training package, aimed at equipping physiotherapists to deliver it. She lectures (UK Universities) and has been an invited key note speaker at international conferences.   Ms. Sowden influences policy and practice through involvement in projects and membership of societies and committees. She is a member of an implementation team (Impact Accelerator Unit) and a NICE Fellow Alumini.





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