Awesome suggestions, thanks for sharing! I am definitely an over-educator and have been trying to focus more on just the tip of the iceberg to share with my patients lately. It’s easy to forget not everyone has the same educational background and when you are thinking you are helping with giving them information, they may only be retaining bits and pieces and sometimes, those bits can be construed into something completely different than what you intended. I am learning, less is more.

For patients whom I suspect have some central hypersensitivity, I have found it helpful to explain to them that when you are in pain, your brain changes and starts to interpret touch that is not harmful as painful (easily proven by gently touching their leg, for example and helping them make the connection that touch from their finger gently on the skin does no damage, however, for some reason, they still feel pain). I think patients appreciate when we acknowledge that there are actual changes in their brain that they can’t control, versus them making it up or being crazy (I find that a lot of patients that have dealt with many doctors or unsupportive family members suffer from this fear). Once they understand that the brain has made some changes, I then tell them it is their job to help retrain the brain and help reteach it what is painful/harmful and what isn’t again. If they can understand that the brain is faulty at interpreting pain, and not that they are actually hurting themselves, then they are more willing to work through some pain in an attempt to help play an active role in “reteaching” it. This hasn’t been enough for everyone, but it has helped me get over the hump of willing to participate despite some pain with some patients.

Hey Casey- I really like that idea. I was just telling Michelle at lunch that I had a 27 yo. female patient in this morning who’s a grad student at UVA. She has complaints of neck pain with cervicogenic headaches (I see a lot of these patients secondary to poor postural habits with academics). However while I was working with her this morning she told me her R. shoulder had been hurting and then her R. ankle had started hurting when she went on a short walk. Per her subjective hx, she is a healthy young lady with no previous orthopedic hx or co-morbidities. Therefore I definitely think she may be demonstrating some central sensitization as she’s explained her neck has been bothering her for some time. So I definitely used the ankle/twig story this morning, haha. But I really like the idea of actually touching her leg with some gentle pressure to see how she responds. I think that will be another great platform to educate her on how the brain is changing and possibly perceiving non-noxious stimuli as threatening. Nice suggestion Casey. I’ll keep you posted how it goes. Spring Break is next week so it may be in 2 weeks, ha.

Stephanie and Casey- I enjoy hearing your process with patients and how to educate the patient on the change in pain threshold and the change in the neuromatrix of the patient’s brain. It is very difficult and you have to make sure you are putting your words in the right context when you say “it’s all in your head”. From Eric’s lecture and from listening to Louie Puentedura, using video or images (“Why I hurt” cards) have helped quite a bit, especially with individuals returning to a work setting and have a high FABQ. As well, Aaron and I have gone as far as allowing the patient to watch the Lorimer Moseley TED talk (in side lying) while doing Elveys for lumbar spine. The neat thing about this patient population is that you can be creative and tap into your non-ortho skills. From the article, I think this is a good start to quantify a person’s pain response. I do see the ultimate limitation that pain is an output and there are a million and one variations of how pain is generated and then processed as an output from each person. As well, the population measured in this article is those with chronic pain but I wonder how different those with simply a “revved up” nervous system would vary.

Hey guys,
Sorry to jump on the bandwagon late on this one. Great article on central hypersensitivity and something that we may not think of initially when our patients complain of pain. I have one patient in particular that I think of with this topic. He’s an active college student that has been coming to the clinic since November for bilateral shoulder pain. He presents with significant bilateral shoulder instability and secondary impingement as well as scapular dyskinesia. He has been treated by three different therapists with minimal symptom relief. Pt. had exploratory arthroscopic surgery two months ago and the surgeon found nothing structurally wrong with shoulder. He reports no symptom relief following surgery and continues to have subjective reports of significant pain with even the most basic exercises and activities. His orthopod also prescribed him an anti-inflammatory. After reading this article and the posts, I stole one of Eric’s analogies (thanks Steph!) and had a conversation about his symptoms last week. Kyle—great suggestion about using the “Why I Hurt Video” –that might be something beneficial for my patient to watch as well.