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Hello all,
I had an eval Tuesday during mentoring hours that led to discussing the recognition and management of significant psychosocial factors contributing to pain. This patient gave examples to fill every category of the psychosocial pain chart.
43 y.o. female, left shoulder pain onset 2008, MOI: Arm stuck in a car window, pulled by the car and fell onto left shoulder, on disability
Subj: Aggs- closing car door, reaching, lying on left shoulder. Ease – none
Obj: Flex/Scap/Abd less than 80 deg. PROM severe muscle guardingCognitive (expectations, catastrophization) Example: Shoulder hurts all over. Everything hurts. I feel like I’m falling apart.
Emotional (anxiety, fear, anger, depression, stress) Example: I can’t get any sleep, tired all the time, I don’t go out or socialize because I’m in pain all the time. I can’t lift my arm up.(apprehensive about all shoulder movement)
Behavioral (Avoidance, Coping) Example: I don’t use my left arm for anything most of the time. Try to lie down and take a nap but can’t sleep.
Social (Work, home, relationships) Example: I need to be able to drive to pick up my granddaughter. I spend time with her but I don’t get any adult conversation.
Motivation (Readiness to change) Example: I do not want surgery. Would like to get out and walk for exercise. If my shoulder didn’t hurt so much, I’d be able to work part time.
After ineffectively teaching her a scap retraction exercise, I made sure to emphasize that she will not damage tissue with gentle exercise, basically using the “hurt does not equal harm” concept to attempt decreasing some of her fear of movement.
With that said, does anyone have any go to metaphors/anecdotes for helping the hyperprotective, fearful patient understand pain?
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Hey Justin,
I recently evaled a patient with central sensitization following an infection in his hand, he presents with shoulder and neck dysfunction/pain. AJ sent me several good articles on central sensitization (which I have attached) involving what it is, how to explain it to patients and some treatment strategies. I don’t know if these will be super applicable to you and your patient, but I found them very helpful with my patient!
Best of luck, these patients are tough!
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Hey Justin,
I’m treating a couple of patients currently with similar issues. My favorite analogy has been to tell the patient that the brain becomes a helicopter parent when the body is chronically in pain. Helicopter parents, much like the brain, will give you no freedom because they are trying to keep you safe when, in fact, they are doing more harm then good. Maybe that will be helpful for your patient. Good luck!
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