Pain from the patient perspective

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    • #7471
      AJ Lievre

      An interesting blog post from a PT who suffered from chronic pain

      Have a read

    • #7476
      Erik Kreil

      I love how Karen explains her pain as a journey. It can be easy for me to be off-put as a patient aggressively describes their pain experience haphazardly between the ages of 2 – now as a 63 year old adult. How often do I ask myself not only who this person is but why?

      The author was once a “confident, strong woman,” but she transitioned into one who is “timid… [and] unsure” as the pain “took over” her life. Why did my patient get to the point of feverishly describing their pains the way they chose to? Karen’s descriptors as “consuming” and taking over her life make me wonder about chronic pain’s effect on a patient’s locus of control.

      Was it the fear that ate away at her innate personality, or more so the feeling of ineptitude as a physical therapist to defeat her own musculoskeletal pain? I can imagine that strong, nagging negative emotions can break through the floodgates and begin to overwhelmingly dictate their self-talk and personal ego – changing maybe not who she is but how she is.

      It’s my belief that pain, when experienced over longer periods of time without relent, can entirely change the presentation of a person. Wondering if other people agree, and how you all feel about our duty as a musculoskeletal expert versus having a responsibility to affect how this person is being as a result of chronic pain?

    • #7478
      Matt Fung

      Erik I think the quote you highlighted was one that stuck out to me the most when I was reading Karen’s passage. She notes that she was once a strong confident women who is now withdrawn, timid, and questioning her future. I feel that these worse exemplify how many individuals who suffer from persistent symptoms describe their journey. Our job is to address their current fears cautiously and identify areas of strength for these patients that can hopefully restore some confidence.

      By the time these patients present to us typically they are only a shell of themselves; as Karen mentioned, “..pain took over her life, her thoughts, decisions and even her personality..” Educating these patients that we are not going “fix” their problems in a few visits and setting realistic expectations is essential for these patients. Much like Karen’s story, patients who suffer from persistent chronic symptoms there was not direct mechanism that caused their symptoms or if there was tissue healing time has passed. Thus, we need to identify their functional deficits and implement strategies for them to complete these tasks to create positive change.

      To your question Erik, if a patient present to me with chronic symptoms, being a “musculoskeletal expert” I would assess them as a whole and treat the person in front of me as we normally would, addressing any biopsychosocial factors that may be identified in the process. To me, not much changes. We need to treat the person in front of us as a whole as we would with anyone.

    • #7479
      Jon Lester

      I agree with both of you guys. I think that treating this person as a “MSK specialist” only would not only be inappropriate, but could also make her symptoms worse. I’m picturing this person as not only having constant fear and pain, but perhaps hyper-analyzing everything in her life that could contribute to her symptoms. If we step in and tell her 10 objective findings that were “positive”, is that going to reassure her of possible ways to help (how we might think) or affirm to her that she is “broken” and structurally faulty (how she might interpret them).

      She herself states that she is fearful of movement, activities, and other parts of her everyday life due to the thought of making the pain worse. If we don’t address this and educate her on the resiliency of the human body, we might be missing a huge aspect that could benefit her. Just because she is a physical therapist does not mean that she has delved deep into the non-mechanical contributions of her pain and this is a way that someone could help her.

      This shows that anybody can experience chronic pain and be stuck in the vicious cycle that it causes. I’ve had people tell me that it feels like a vortex and every time they start to feel like they’re getting out of this vortex it feels like they immediately get sucked back in. This is definitely a challenging patient population to work with, but giving them 5 different pain medications and sending them on their way is missing a big piece of the puzzle.

      I’m curious, how do you guys treat people with chronic pain? Especially those with a history/background in the medical field? I find this challenging and often more difficult due to their base knowledge of the possible mechanical/biochemical problems that might be present. Curious to hear everyone’s thoughts.

    • #7481

      I agree that it is easy to think of chronic pain patients as aggressive, uneducated, and unwilling to change – without thinking about why they are that way – and I think this article does a great job of highlighting their POV. Erik to your question, I think that we have to address both aspects, but will likely spend more time on treating the patient’s biopsychosocial aspects of their pain.

      Most chronic pain patients have gradually shrunk their lives smaller and smaller as their pain has dictated them do so. I feel as though our job as PTs is to begin to make their worlds larger and to help make their pain less detrimental to their overall well-being. As Karen stated, the pain is always there, but what Karen has been able to do that many of our patients have not, is to generally still enjoy life and do activities she wants to.

      The quote that stuck out to me was “I connected FEAR to my pain […] fear is tattooed into the amygdala. As we go through life these tattoos can be inked in strongly or lightly.” This reminded me of the fear I had with driving after my car accident in Sept, and how I can parallel this to a patient with chronic pain (In the paragraph below, I put in parentheses how different aspects of my experience is similar to a patient who has fear of movement). I feel as though my experience with the MVA helped me empathize with my patients and have a better understanding of some of the thoughts and fears they may be feeling.

      When I had my MVA, I was driving and then hydroplaned. It wasn’t as if I did something – I was driving normally and the next thing I knew I was crashing (Onset of pain). The next few months I had really high levels of fear with driving, especially if I was driving at night, in the rain, or on the highway, because this is how it was when I crashed (Fear of movement, especially if it is similar to the MOI such as bending, lifting, etc). The “fear tattoo “was strongly inked into my brain. I drove much slower than the speed limit, and even a gust of wind would scare me (Bracing, making sure to not forwards if picking something off the ground). It got so bad that I got my new car checked out because I was convinced that there was something wrong with my car, when really it was just that I still had a lot of fear and anxiety (Going to multiple physicians, getting unnecessary tests like MRIs). I started to take the longer way to work in order to avoid driving on the highway (Letting pain limit activities you participate in, especially ones that you enjoy). Eventually I began to force myself to drive on the highway at night and in the rain and to not go ridiculously slower than the speed limit (Graded exposure, breaking up painful tasks into smaller and more manageable activities). The more I did this the more confident I felt, but it took a long time for me to really feel like I was in control again.

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