Talking to Patients About Stress

[AJ Lievre]

I know this is a difficult topic to discuss with patients as you often are trying to validate their pain while pointing out that stress in their lives may be contributing to their symptoms. Also, sometimes people don’t realize how much stress they may be under, or how management strategies are so important.
Here is an inventory that I have come across in one of my classes that you might find useful to get the person to reflect on what is going on in their lives. It also discusses coping strategies without you having to get too involved if that is not your comfort zone. It may be an easier way to start that dialogue anyway.
Let me know what your thoughts are on this. I have a few more inventories that you might find more useful. Let us know if you are challenged with the stress conversation with patients or if you have found ways that work well.

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[awilson12]

I think that using outside resources to address difficult topics is a great way to start the conversation as well as address different aspects that you don’t usually think about or consider. So definitely open to any and all resources to help with this!

Stress in particular isn’t necessarily hard to ask if someone is experiencing and I find that a lot of people can identify relationships between stress and pain. But what is difficult is nailing down specifics of their stress, methods of stress management that they have tried that work and don’t, and offering more suggestions on other ways to cope. Additionally helping them make the connection between stress and pain to where it just isn’t a concept but something that can be used as a treatment strategy for pain is difficult.

I like that in this inventory they address the pain and stress relationship in an understandable and relatable way. I also like the checklists that can provide a good visual to evaluate the number of stressors, how this manifests physically and emotionally, and strategies for preventing and coping with stress. I think that this won’t work for every patient because of the length but have a few in mind that would be open to reading and filling this out.

[Kyle Feldman]

I had a patient come for her 3rd visit who has been experiencing 10 years of chronic pain.
We had the typical talks, manual, and graded exposure to exercise and improvements were being made.

When she arrived for this session she was rushing, flustered, all over the place, and panicking. Her pain was back up to a 5/10 so I decided to take a new route.

I shut the lights off, had her lay down and we just did meditation and deep breathing. She did it for 5 minutes and after that I said lets start over. She walked out of the door and entered the clinic again.
She had a completely different mood, affect, and presentation.

Her pain was a 2/10 now and we ended the session painfree, sweating, and fully exercise based.

She expressed her realization of stress effects on pain and I plan to use this intervention for other patients who come in like this in the future.

Has anyone else ever tried strategies like this?

[awilson12]

Kyle- Thanks for sharing. I haven’t specifically used that strategy or something similar, but good to have in the back of my mind if a situation warrants this type of intervention. I do often use deep breathing with these patients though when doing exercise and have mixed results, but often see a good response in terms of tolerability to exercise and movement.

[pbarrettcoleman]

Many of my patients with a little bit of leading questions for self-discovery can make a strong relationship between their symptoms and stress, but I do a poor job of then leveraging that to show them techniques to reduce their stress. I think I avoid it because what we tend to offer is meditation, breathing exercises, and things that can come across as hokey.

I’ve seen Anetta use what she calls “spinal decompression” with breathing for a certain count (in for four, hold for 6, and release for 8 or something another). I liked this approach because it’s nothing more than mediation and focusing on being present but presenting it within biomechanical language and linked to the pt’s main complain (their back pain).

[Taylor Blattenberger]

In my experience, the most difficulty lies in finding a daily stress reliever. I feel a lot of the people I see may be able to identify stress but see it as unavoidable: “I can’t stop being a mom,” or don’t have leisure activities when I ask them about what they do for “fun.” I found value in this hand out in the areas with suggestions for activities. This can open deeper conversations about how to make small adjustments in their day to provide a small escape.

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