August 19, 2020 at 8:45 pm #8745Steven LagasseParticipant
Hey everyone –
Since my journal club I’ve been reflecting on ways to incorporate more discussion with my patients regarding the biopsychosocial component to pain. There has been A LOT of good discussion when I bring these topics up to my patient’s. I will often attempt to open the door to discussion by normalizing the matter – something along the lines of, “I’ve heard a lot of other patient’s tell me they are fearful with movement, do you think this pertains to you?” If they bite I’ll then ask more. I’ve added the following questions to the flow of my subjective exam, weaving them in as appropriate.
– Do you experience fear when your symptoms come on? Are your symptoms due to fear or strictly discomfort/pain?
– Have you felt the need to remove yourself from certain work / social / or
physical activities due to your symptoms?
– Do you experience increased symptoms with stress / anxiety or depression?
– What are your beliefs regarding painful movement? Do you think painful movement is damaging?
What do you all think? Are there other questions you ask that have been helpful? Do you have other ways of addressing this?
August 23, 2020 at 9:26 am #8746pbarrettcolemanParticipant
I like these questions.
It all depends on the person in front of me. I follow the typical schema of any subjective exam so I typically ask questions during the aggs portion of my exam like are there other things that make their pain worse like weather, not sleeping, and stress. Likewise with goals, I tend to ask those questions about fear or missing out on social things here. Sometimes the functional questionnaire has picked up on this so it opens up a venue to talk about it.
During the wrap up portion if I feel i’ve built good rapport, I’ll ask them if anyone has every explained why they are in pain for such a long period of time (if they are a persistent pain patient). Usually this opens up a good window to do some pain science education and give them a nugget to keep coming back.
August 23, 2020 at 9:00 pm #8748Michael McMurrayKeymaster
I think all of those questions are really good and important to incorporate into not only the eval but throughout the POC as well. These are the types of questions that, unfortunately, I think get overlooked and may have a huge impact on their recovery both short and long term. These may be the key questions that may have been overlooked from other providers.
It all depends on the patient but I usually ask similar questions throughout the evaluation especially when going through the SINSS and clarifying if it is pain or fear, or both which limits the movement. I again ask that throughout the objective section too if they are apprehensive. There is a fine line as well though, as it is important that they aren’t focusing too much on the pain itself.
Another question that I tend to ask is do they notice their symptoms more while they are in the same scenario. For example, my clinic sees a lot of MVAs and I often ask if they are afraid to drive or if they feel their symptoms increased while driving. In certain instances I think there can potentially be PTSD related to injuries that often are over looked.
August 31, 2020 at 11:48 am #8760awilson12Participant
Steve- I, too, have tried to be better about adding more reflective questions during my initial evaluation and subsequent treatments. They just give so much more helpful information a lot of time. I feel like I don’t often directly ask if people are scared of movements, but, in some situations, can see how this would be helpful then follow up with a question on why they believe that.
Barrett- I like that last question and don’t know that I have ever asked it in that way but can definitely see how that is helpful to get them to reflect and also open up a door for us to start the discussion.
I also think that just asking what the patient what they think is going on or what all of the medical “diagnoses” they have been told mean to them is useful as well.
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