sofmmoo.com FIMM et SOFMMOO Fédération Internationale de Médecine Manuelle

The 14th Triennial FIMM World Congress, Bratislava, Slovakia, September 15 -18, 2004
EVIDENCE AND NEW CHALLENGES

Jacob Patijn, MD, PhD, Chairman Scientific Committee FIMM

The theme of the next triennial World Congress of the International Federation of Manual Musculoskeletal Medicine (FIMM) comprises different aspects that reflect both the current developments in the general medical scene, and also the current position of Manual Musculoskeletal Medicine in relation to other disciplines. Two important developments will change the future face of Manual Musculoskeletal Medicine: Evidence-Based Medicine and a changed paradigm to approach the pain problem. Pain management and Manual Musculoskeletal Medicine are inexorably bound to each other. Despite extensive research into the aetiology and different mechanisms of acute and chronic pain, its management remains a challenge for ail heaith care practitioners. Nowadays, pain has become an important issue in many national health care Systems because of its economie consequences. However, pain is not exclusively related to Manual/Musculoskeletal Medicine, but forms a major problem for all clinical disciplines in medicine like neurology, orthopaedics, rheumatology, rehabilitation, psychology etc. In recent decades the approach to pain as a symptom has gradually changed. Most of us were raised with the idea that pain was mainly explained as a consequence of tissue damage. Diagnostic procedures and therapies were mainly aimed at finding a somatic diagnosis and therapy. However, this biomedical approach could not explain the chronic phase of pain in which the tissue damage was supposed to be healed. Also psychodynamic models, which suppose an intra-psychic conflict as the reason for chronic pain, failed. Pain research has shifted from a mono-causal relation of pain to more multi-causal explanation models for pain. In current pain research, the bio-psycho-social model of pain includes both the somatic aspects and the cognitive behavioural, emotional and social factors that can influence pain. This model provides a framework for a multidisciplinary and multi-modal therapeutic approach, not only for the pain problem as such but also for the individual patient with pain originating in the locomotor system. Treatment routines have begun to change to reflect this thinking.
A second and already existing trend that has and will certainly continue to influence Manual Musculoskeletal Medicine in the near future, is Evidence-Based Medicine. In our discipline, the results of efficacy studies and meta-analysis are often contradictory. The same is true for studies about reproducibility, validity, specificity and sensitivity of many of our diagnostic procedures. For many practitioners the Evidence-Based Medicine trend has a threatening character because certainties, such as the efficacy of therapies taught by our educational boards come under debate. Nevertheless, we have to integrate this trend of Evidence Based Medicine in order to grow into a profession which can show that our practitioners can provide our patients with the best and rnost effective therapies. But Evidence Based Medicine is not synonymous with the idea that we can only perform therapies and diagnostic procedures that have been scientifically proven. In that way Manual Musculoskeletal Medicine would become a kind of "cook-book medicine". At the moment, practitioners in Manual Musculoskeletal Medicine have to use the evidence from research in combination with their clinical expertise to look for the best therapy.

For Manual Musculoskeletal Medicine, integrating new trends in pain management and the achievement of Evidence Based Medicine are the main challenges for the future of our profession. For its practitioners, the challenge is to develop a more critical attitude toward our beliefs, our work and its effect on patients. For FIMM, the challenge is to form a non-political environment where discussion about our discipline can take place. For educational boards of the different national societies of FIMM the challenge is to make their educational system more evidence-based.

The FIMM World Congress in September this year has a format of plenary sessions, workshops and posters. It will provide the different schools in Manual Musculoskeletal Medicine an opportunity to present their views. It will provide researchers the opportunity to inform us about the latest achievements in an evidence-based way, as well as the opportunity to pick up new ideas for further research.