Since starting at UVA, there are few familiar faces in patients that I helped treat during my time here as a student in the spring. One of those previous patients was on my schedule last week and she has one of the more difficult presentations that I’ve seen in my time in any physical therapy clinic. The patient is a 44 y.o. Female who presents with a primary diagnosis of Ankylosing Spondylitis with a long history of chronic LBP and many of the hallmark signs of Central Sensitization, including hyperalgesia, pain catastrophization, diffuse pain distribution, and many contributing psychosocial factors. I only saw her 3 times when I was here as a student, but felt like we had made some progress together and she was incredibly receptive to the education I provided on graded exposure techniques and utilizing exercise to help modulate her pain. One of her biggest fears is climbing stairs, which she compares to climbing Mount Everest, and when I first evaluated her, she mentioned that she has to use her Mom’s stair climber to get to her bedroom.
I saw this patient for the first time since I was a student last week and wanted to share some of my thoughts as I reflected back on this specific encounter with her. We spent the beginning of the session discussing how she has been doing since I last saw her and how her rehab has been going overall. She recently had her Mom pass away and understandably so, she was having a hard time. It was also apparent that this significant psychosocial event had an impact on her pain response as she mentioned that she had a significant increase in pain in areas that she hadn’t experienced pain in for years. We spent much of the session talking about her personal life and her coping mechanisms for the level of pain she was experiencing. I provided education on sleeping strategies, aerobic exercise, and graded exposure to help with pain modulation. I was able to provide some low grade manual therapy to her shoulder and upper thoracic spine, where most of her current pain was culminating. We were also able to do light resistance exercise aimed at promoting mobility in those same areas.
As I reflected back on this encounter and thought about what I could’ve possibly done differently, I realized something I sometimes struggle with as a clinician is the language I use and how this can sometimes harm the patient in front of me. More specifically, I noticed myself in this patient encounter using words that she would often hold onto between visits in a negative light. Motivation is definitely difficult to achieve with her as she is weighed down heavily by her diagnosis of AS, despite a more clear clinical presentation of central sensitization, although I try not to point that out in a manner that shuts her down. She was more receptive to pain neuroscience education than I anticipated, but I still found myself using words like “chronic” or “wear and tear” or “inflammation” and realized she would hold onto those words and repeat them when negatively referring to her own presentation. I definitely have come to appreciate the “Sticks and Stones” article in JOSPT and hope I can start to develop a better habit of using alternative words as I reflect on the impact of my language on patients. I would love to hear any pieces of advice from anyone on alternative words they like to use or even particular ways of explaining pain/injury to individuals dealing with long term, heightened pain.