I think hypervigiliance is a tough one. I feel like implying that we ignore their pain leads to the idea that they just have to learn how to “live with it” which isn’t the message we are actually sending. For me it’s particularly tough because I always screw up and ask them how they are feeling after interventions out of habit.
Not that this is a success story, but I am currently working with someone in their 70s with chronic pain, body chart 80% colored in kind of deal. They fell on their knee 6 months ago and fractured their patella. Their entire R LE now has allodynia and lots of pain which was her primary complaint, but if you got her talking, she would talk about her entire body and how it’s been that way for 40 or 50 years.
I’ve been performing desensitization techniques, pain science education, and just general movement to some success. However, during any intervention she was more than willing to tell me every little thing she felt, particularly during glute bridges. Thankfully, her pain kept moving around during this intervention (it was in her buttock, then her hamstring, then her core, then on the front, then her ankle).
I was able to use this as a springboard to tie in what we had talked about with pain science and check her understanding. I would ask her what she felt the reasonable explanation was for why her symptoms moved around so much and often times she would say she didn’t know. That meant I did a poor job of educating her and relating the pain science to her situation. After this happened several times where I was able to fill in the gaps, I’ve noticed that she’s reporting every little thing she feels less the greater her understanding of central sensitization becomes. We were also able to begin talking about how not every sensation = pain, tissue damage, or problem, and that there is a difference between the feeling of a stretch and tissue damage.
I was helped in this particular situation because her hypervigilance was paired with widespread symptoms that can’t make any sense. Therefore, I could politely challenge her to explain it and then reframe it with the missing gaps from pain science education. I think it would be much harder if it was a localized spot like the low back. I’m not sure how I would go about that situation.