Many patients attending pain management services have previous experiences of trauma, with disclosures often emerging during treatment. Clinicians can find this hard and may lack skills, confidence and training to deliver psychologically informed care. Struggling to support people living with complex and chronic conditions, where distress is commonplace in clinical encounters and can lead to professional demoralisation and burnout. Emotions are central to human experience, relationships and an inextricable part of care. Distress is a common and often reasonable response within persistent pain care contexts, especially for people who have experienced trauma. However, distress is often pathologised and individualised and poorly navigated by physiotherapists. In this presentation we describe how current physiotherapy practices can be rational, task orientated, and focused the body in pain. Such approaches can unintentionally neglect other dimensions of the human experience, including emotions. This may negatively impact clinicians and patients, risk re-traumatisation, and limit the development of trusting and safe therapeutic relationships and spaces. We draw from sociological theories of emotions to propose a more relational approach to care, shifting the focus beyond the individual in pain to include the physiotherapist and the many social, cultural, political, and structural forces that influence relation-centred care. We explicate why this is necessary when working with people who have experienced trauma. We will also present findings from a qualitative service evaluation exploring patients’ experiences when engaging with persistent pain services. Emerging themes suggest patients can feel safe in a ‘bubble’ of care as compared to the threat of outside, experience a transformation over time toward sense-making and discovery but there is a risk of re-traumatisation. We offer recommendations to inform clinician training and practice. Psychologically Informed Collaborative Conversations (PIC-C) is a co-produced training and supervision package that has been shown to be effective in improving the skills and confidence of physiotherapists managing adults with pain. It is also suitable for delivery for paediatric professionals and has a positive impact on physiotherapist’ confidence in using psychologically informed ways of working. An important theme from participant feedback was the emotionally challenging nature of the training but that this ultimately was a valuable and affirming experience. Finally, we will draw on the experiences of providing rehabilitation in UK-Med’s Emergency Medical Team Response in Gaza to explore the application of a trauma-informed approach to experiences of acute and persistent pain, historical trauma, ongoing stress, and life-changing injuries. Building on the previous content shared in the session, examples will demonstrate how physiotherapists can consider in their treatment the emotional experiences and social, cultural, political, and structural forces that shape the person’s lived experience of pain. Additionally, examples will illustrate how a de-pathologizing approach to understanding cultural idioms of distress and cultural healing practices can be integrated into physiotherapy clinical practice as a method of embodying a trauma-informed approach to pain. As feasible, the presenter will integrate the lived experiences of rehab providers in Gaza. The symposium will conclude with an interactive session enabling further exploration of attending to the human aspects of care.

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