Patient info/edu pamphlet

[Jon Newman]

I'd like to introduce a project and invite contributions from everybody interested. The idea is to develop a pamphlet for patients (or potential patients). The focus of the pamphlet would be pain related. It would be of the ubiquitous tri-fold type found in most health care settings so keep that in mind when submitting ideas.

Eventually we will create a pdf of the pamphlet for anyone to download for personal use. The first column will have very little on it beside a title so as to leave room for your own personal logo.

To try to get the project rolling I'll suggest the title

Do you understand your pain?

but feel free to contribute your ideas also.

Some other ideas to get the body of the project going would be


Did you know that pain is often the primary reason people go to their primary care physician?


Did you know that pain is always a neurological event whether or not it is associated with a detectable injury?


You may have wondered why you have pain but no one has "found anything" or why your pain behaves the way it does


Your physical therapist can take the time to discuss your pain experience and help you make sense out of it


Post your ideas for blurbs or even how it ought to be developed and we'll get this project underway.

[Pete]

Hi Jon

I have a question: is the leaflet intended as a piece of marketing literature (ie, available to people who might not otherwise come across your services), as something to give to people at the end of a consultation, or as waiting room reading for people who are about to have an appointment with you. If the latter, I can see one disadvantage: some patients might read it and think "this guy will try and tell me my pain is all in my head. I'll need to work hard to convince him that I have a real problem". As a patient, I *think* I would feel more comfortable with a sequence of (1) thorough examination to rule out a 'tissue' problem, then (2) education re pain, perhaps including the leaflet as a take-away resource for them to read after the consultation.

In terms of the content:

- I'd kind of assumed that pain would be the primary reason why people go to a primary care physician (but that might just be me extrapolating from my own experience). Either way, I'm wouldn't be particularly interested in that fact. If you're short of space I might leave that bit out.

- as a neurotic hypochondriac 'neurological event' makes me think "ohmygod I've got MS" or "the pain means I'm going to have a stroke". I might be more comfortable reading something along the lines of "sometimes your nervous system keeps on sending pain messages after your body has healed."

- Personally, as a patient, I'd want to see more emphasis on "we can give you the tools and knowledge to help you to reduce or eliminate your pain" and a bit less on "we can help you understand/make sense of it".

- The bits that stayed with me from 'Explain Pain', and which might be worth including are "Hurt doesn't always mean harm", followed by a short explanation of what this means, and something along the lines of "modern science has given us lots ways to help you manage or reduce your pain and do the things that pain currently prevents you from doing".

- It would be great to have references for further reading. 'Explain Pain' being the obvious example.

- I found that the first chapter of Louis Gifford's 'Topical Issues in Pain' (volume 1) had a load of really interesting, encouraging and relatively accessible material on pain that might be worth drawing on.

Overall, I do think it's a good idea and I wish I'd come across a leaflet like it two years ago.

Pete

[Jon Newman]

Here's a few more ideas for the body of the pamphlet


The strategies you use to help build muscle, endurance or stretch tissue may look and feel differently than those things you do for pain relief

Learn how your environment and culture may influence your pain experience

Learn more helpful ways to rate your pain than simply assigning it a number

[Jon Newman]

Hi Pete,

This is intended to be one of those pamphlet that lives on a wall with a bunch of other pamphlets that people pick up because of whatever reason they pick them up. It could be delivered to someone specifically also as it seems appropriate.

I wish I'd come across a leaflet like it two years ago.

In retrospect, what knowledge would have helped two years ago?

Thanks for the input so far. Eventually we'll have something to offer.

- Personally, as a patient, I'd want to see more emphasis on "we can give you the tools and knowledge to help you to reduce or eliminate your pain" and a bit less on "we can help you understand/make sense of it".

Maybe something along the lines

Paraphrased from Barrett (without permission as of yet)



While effective therapy emerges from you and not the therapist, your therapist's understanding of pain can help your recovery

[BB]

Here is something I wrote yesterday for a newsletter I'll be sending out for my clinic. Coincidental timing:

We Ignore Pain at Our Own Peril
I see many people who have all sorts of pain. My job is to help them to resolve it. People have all sorts of ways of coping with pain, and one that I see frequently is to ignore it. We ignore pain at our own peril. Let me explain.
Pain is our body’s method of protecting us from moving in concerning ways . Ignoring these warnings is not a good idea. For example, when the temperature light comes on in your car what do you do?
You could take out the bulb to the warning light, but this would not make the problem go away. This is similar to distracting yourself from the pain. It shuts the warning off for the time being, but the problem doesn’t go away.
You could just keep driving despite the light. This is akin to moving despite the pain. You keep getting things done, but again the problem does not get resolved.
You could pull over and get the car checked. If you check it early enough you may find the coolant system is all that is affected. If you wait, other engine areas may become affected. This is the same for pain. The long term solution is to resolve the problem causing the warning, not the effects.
To treat the cause of pain instead of its effects, the origin of pain must be known. If the nature of your pain is affected by movement or positioning, you likely have pain of mechanical origin.


Nod to Lorimer Moseley's "Painful Yarns"

[BB]

Also this:

Do You Hurt When You Move?

If you hurt with movement or positioning you have pain of mechanical origin. Many diagnoses include it: low back pain, shoulder pain, impingement syndrome, muscle strains, tennis elbow are but a few common examples. But what is it?
This simply means that your body has become sensitive to certain movements and creates pain to protect against those movements (see above).
The protective state of the body must be lowered by addressing the sensitive structures. To achieve this, gentle handling, movement therapy , and education are used to painlessly bring relief.

[Barrett Dorko]

PERMISSION GRANTED

(Read aloud with a deep stentorian voice)

[BB]

Might I suggest a 3 pamphlet series:

Pain

Your role in your recovery

The therapists role in your recovery

[Jon Newman]

Sounds good Cory if we develop enough information for each. If not, perhaps that can be the categorical unfolding of a single pamphlet.

Perhaps if people would indicate the category(ies) where their contribution would best go by entering it in the "title" box of their post.

We can call the categories

pain

patient

therapist

[Diane]

Jason's "Corrective Movement" handout , or excerpts from it, could be woven in. If it's a trifold, then there are three x two sides, or six available spaces.

[Crazy Pole]

Hi Jon,

Pretty good idea, except I'm concerned.

Regarding the clinic you are at, the entries in all 3 sections (most notably, the PT's role), would not be universal to all PTs there. I (think I) know where you are trying to go with this, and I envision glaring differences between co-clinicians and yourself. Surely, this scenario is not isolated to your place of practice.

I hate being pessimistic, and I really do hope it works for you. But, I'm pessimistic...

Wes

[nari]

Wes, I tend to agree with your points. (That does not mean the plan does not go ahead successfully.)

Jon, what are the chances of challenge by your colleagues along the lines of:

What the heck are you talking about here, Jon? I'm not giving this out....has it been approved....patients won't understand.....I don't understand etc etc.

Like Wes, I think the questions will come from PTs re the pamphlet's validity. Patients will probably welcome a 'view' that resonates with their perceptions.

Nari

[Jon Newman]

Hi Wes,

What gets produced here may not be of use for everyone but it is a resource I think we could produce for those practices that could accomodate it. Also, I don't think there would be anything in it that is untrue, so that's good.

Of course if the pamphlet were used here (SMH) it would have to be approved by the management as well as survive the inquisition of some sort of committee. Luckily for me I would be able to defend the contents. The worst that would come out of it is that they wouldn't ask me to produce a pamphlet on pain again.

Can someone link Jason's handout here?

[christophb]

I was about to ask the same thing about Jason's handout. Is there a nice little place on soma where the educational tools/handouts are gathered?

Cory, Like the 3 pamphlet idea... wouldn't fly at my clinic to have them in the front office, but I would certainly hand them out as required reading after the first session.

Chris

[Jon Newman]

wouldn't fly at my clinic to have them in the front office

the entries in all 3 sections (most notably, the PT's role), would not be universal to all PTs

I think these are valid concerns but I think it is possible to produce a pamphlet that is truthful and applicable to most practice settings. Just consider the above concerns when submitting suggestions.

[BB]

Page 1

Did you know that pain:

always involves the nervous system?
is meant to protect you?
often happens without injury?
often is present even though all tests are normal?
should not be ignored, but also should not be avoided?

Did you know that there are explanations for all of the above?

Page 2

Summary of jason's stuff

Resolving pain

A famous and influential neuroscientist named Patrick Wall suggests that 3 stages are passed through on the path to resolution:
1) withdraw
2) protective posturing
3) movement toward resolution

Each stage has distinctive features and the process can be delayed at any stage.

Page 3

The origin of pain

The manner in which a person is guided through the stages of resolution depend upon the origin of pain.

Luckily the origins of pain are few, and their features are easily distinguished. If your pain is affected by movement or positioning there is a mechanical origin to your pain. Pain of this nature is suited to be treated by physical therapy.

[Diane]

Here's a link (http://www.somasimple.com/forums/showpost.php?p=32793&postcount=16) to Jason's already very succinct handout on Corrective Movement.

[Jason Silvernail]

Well, here are the two handouts I use most often.

I think a brief explanation of the difference between tissues is important. People often express a frustration that their problem is not 'healing' soon enough.

I use the water the grass analogy to explain why nervous tissue is different from other tissues and why it has more needs and an uncertain time course in the healing process. Also I keep a Magic 8 Ball (http://en.wikipedia.org/wiki/Magic_8_ball) in the office that I sometimes pull out and shake to provide answers when a patient asks something that no one has any way of knowing. Usually it goes over well if you pick the right patient. And of course I'm 100% accurate at that.:D

But I think explaining why things can be persistent and what's required for healing would help. It would demonstrate a knowledge of the body and of pain that few people in the medical system possess. This does wonders for credibility, as I'm sure you all know...

[emad]

Jason , Good work to make it easy for patients ,usually they are interested in hearing new / similar experssions to understand what is going on . In my town , there is one gynacologist whom usually speak to clients using Daily life examples ,clients like him so much . I believe communication is an art .
cheers
Emad

[Pete]

Jon



In retrospect, what knowledge would have helped two years ago?


1. The 'Explain Pain' explanations of (a) the nervous system amplifying pain, and (b) pacing and graded exposure (especially the bits about not overdoing it on good days or under-doing it on bad days).

2. Jason's 'water the grass' leaflet - this is the first time I've seen it and I think it's a very helpful metaphor indeed. It helps make sense of my experience and would have encouraged me to persevere gently rather than get stuck in boom/bust cycles.

3. Louis Gifford's solid science-based writing on how attitudes, beliefs etc can affect the nervous system's sensitivity (I thought there was some kind of psychological component to my experience but I could only find unsatisfyingly flakey explanations (eg, "your unconscious is trying to distract you from repressed rage by causing pain in your knee").

4. Understanding that pain around a joint might not mean there is anything wrong with the joint itself.

As a patient I might struggle to grasp exactly what is meant by "effective therapy emerges from you and not the therapist, your therapist's understanding of pain can help your recovery ". I guess regular viewers of Soma Simple will know exactly what this means but someone new to all this might find it easier to understand something like "your body's alarm system may have become oversensitised, like a car alarm that triggers too easily, and I can help you learn how to reset the alarm yourself".

I suspect there might be a danger of creating some confusion by offering two seperate pieces of information: (A) Hurt does not equal harm, your nervous system may have become over-sensitised, and (B) Pain is your body's way of alerting you to potential harm. Something in the leaflet to say that you can help patients to identify whether there situation is A, B or a combination of both might be helpful.

[BB]

This is great, Jason. Thanks for sharing your handouts.

[Diane]

There are some other messages that I think would be helpful, blended in somewhere. The first one would be, that pain is "normal" in that it usually only means your nervous system is working to protect you - I guess this could follow the "hurt does not equal harm" message.

The other one I thought of yesterday, and said to someone I was treating, was that getting treatment is like having someone come and check your security system. Neil (in CPPSG) uses the analogy of pain being like an over sensitive motion detector, set with too low a threshold, going off when it sees someone move way across the street. I took the analogy farther, and talked about how usually (thankfully) it's a false alarm; that therapists with experience will help turn off the alarm, help reset it down closer to normal sensitivity, show you how to keep it from sounding inappropriately/how to turn it off yourself. They'll also look around the perimeter for bad guys, and check the doors and windows for any signs of intrusion, of course (structural problems). But they won't treat 'structural problems' if there aren't any. And they won't assume that every pain means a structural problem exists.

[nari]

Pete,

I agree with your point about effective therapy emerges from you and not the therapist

In context, this explains itself, but out of context in a stand alone statement, it is too abstract for therapists and patients to be useful. I also agree that mechanical deformation would not be understood by a majority of therapists until they had covered a great deal of education.

We have to be aware where we are taking these concepts - it is only a small minority who would be able to identify with the statements.

A rule of thumb in writing for the public is for an adolescent to be able to read them, be curious and ask for more.

Nari

[EricM]

Jason,
Thank-you for sharing the 'watering the grass' metaphor, I love it. It works in so many ways. I told it to most of my patients today and they thought it was great too.

[Jon Newman]

Here's a first shot at what I was thinking about. Feel free to download it, make corrections and resubmit it. You can also just add commentary via posts.

We'll tweak it to an arbitrary level of satisfaction and eventually have something those who so choose can use.


ps. I started this on one computer, uploaded at it Soma and downloaded it on another make of computer (as well as a different version of word). It appears I lost the words "understand pain?" following the words, "Do you". The main text starts under the header "What's to understand?"

Room has been left for acknowledgements and citations as needed/desired.

[Diane]

Here is a slightly reworked version of Jon's pamphlet. There is still room for more text. Anybody?

[BB]

Nice work Jon. I reworked it a bit as well. I actually tried to decrease the wording so some nice pictures or illustrations can be added. Also, one pane will be needed for the title. Another for the logo/clinic info, etc.

I shifted tried to leave the content intact, but did change some of the wording a bit. Also, I made more bullet points. I just like bullet points in a brochure. Gives it more a "quick read" feel.

[emad]

First of all ,seems I have problem with my PC so that I can not open the up attached Word files !!

Some ideas which I encounter with patients as advice to them :
Habits :
Most patients do habits in pain-state which may fire receptors and fire Nervous System sensitivity such as
* Pressurising by thumb the tender areas
* Massaging the painful areas and spots using their hands
*Touching regular pain spots


Knoweldge Resource :
Most patients get their information regarding pain from
* Their Past Experience
* Relatives Experience
*Friends

Sleep :
Sleep position affects pain directly

Those 3 points really affects most pain patients .

cheers
Emad

[Mariette]

Yes I have also tried to open the files, but to no avail. Bernard can you please help?
I would like to add the following to Emad's post: What the patient will hear depends on the position you occupy in their "medical authority filing system". This is where Louis Gifford's shopping basket approach comes from....but the neurosurgeon said....
cheers Mariette

[Pete]

Emad, could you say how sleep position affects pain? I'd assumed that this was only for back or shoulder pain. Also, can people control their sleeping position - I had assumed that we tend to move around a lot during the night.

Thanks

Pete

[emad]

Hello Pete and Maritte :

I would like to add 1 point to Habits list I made above :
* Over Motions ,In pain-state patients tend to do habits of motion , in case of upper limb ,they tend to close and open the hand repeatedly long the day time ,There are many reasons behind that tendancy .
Pete, I saw some shoulder cases because of long sleep over the same shoulder e.g. A woman with severe shoulder pain following an ocular operation lenses ,the surgeon advised her to sleep over same side. As well , I see many cases of ulnar ,radial palsies because of sleep ...One of them was ticket collector in Train working in night shifts , as well others whom tend to pressurise the nerve just for load of body weight .Yes , I agree with you rolling all night ,even sometimes I say to the patient just sleep little over the affected side to fear of experinceing new pain problem
cheers
Emad

[Jon Newman]

It sounds like we're developing enough information for a second pamphlet.

I found the missing "understand pain?" and added that bit about culture/environment.

Sorry for those unable to download the pamphlet. I'm hoping we can eventually make a pdf out of it. I think that will help.

[Diane]

I tinkered with it a bit more, added the Butler quote about "hurt does not equal harm", added a sentence about blood flow. Added "Motion is Lotion" before I saw that Cory already put it in, so now it's there twice. Might need to be edited out..

[Jon Newman]

On the topic of universality and accuracy: is there anything in the pamphlet that is patently untrue or unsupportable and could this pamphlet live on pamphlet rack of just about any therapy department?

[EricM]

Sorry for the late entry, here's my version off of the latest posting from Diane.

[BB]

Looking good. I moved the "hurt does not equal harm quote" up. The dialogue following seemed to explain what that meant.

Also, I made it a pdf. Hopefully everyone will be able to read it now.

[BB]

Here is the original, so everyone can see where we started.

[BB]

Jon,
Is there an RCT showing that cold sensation is a part of the protection phase?:D

[emad]

Personally , Never I heared complaint of coldness from Pain patient . Most Orthopedic and CRPS complain of fluctation from hotness to coldness ,redness ...signs of inflammmation .
From where " corrective movment " experssion decended ? meaning ? Mechanical imperssion ! Yes, Mechanical fix !
cheers
Emad

[EricM]

This particular pamphlet does seem oriented more towards being a users guide to ideomotion. Is that the intent? There's still plenty of left-over material for a whole series of pamphlets...

[Diane]

I think I made an error - the "hurt does not equal harm" quote should be from Explain Pain, not from Sensitive Nervous System.

[Jon Newman]

Hi Eric,

This particular pamphlet does seem oriented more towards being a users guide to ideomotion. Is that the intent? The intent of the project is multivalent. I was hoping to start a voluntary team project which we do have going. As is typical, it is largely the mods who are joining up but I think the project has been generally successful on that level thanks to yourself, Pete, Wes, Mariette, and Chris.

I wanted to produce a pamphlet orienting the reader to the ectoderm in order to reduce mesobias (my new word--its open source so feel free to use it). It occurs to me that since expectations are important that creating accurate ones can only be helpful.

I wanted the pamphlet not to be technique oriented so as to be applicable in a wide variety of practice setting. I see what you mean about it heading down the path of being a technique oriented path although ideomotion nor Simple Contact has been mentioned.

What do others think? Are we keeping the focus on pain?

[nari]

As pain is by far the major reason that patients come to us, it seems logical to keep the focus on pain. I think the focus is there.
Although other PTs will be interested in the 'hows', I don't see the purpose of this pamphlet as a means of describing any techniques. That is for the PT to work out.
What we need is a wake-up call to therapists and patients to the nitty gritty of pain physiology and its global impact. Instinctive movement/ideomotion is an essential component of management.
I reckon you guys are on track.

Nari

[Pete]

My take on the leaflet as it stands is that:

1. It is doing a great job of succinctly putting over some information that the majority of patients probably never get to benefit from.

2. I agree with Eric that it seems to primarily focus on ideomotion. At the moment, even as a relatively well-informed patient, it wouldn't help me to experience ideomotion. I think there should be a separate leaflet to cover that topic - explaining in a bit more detail how to do it (or how to let yourself do it). It would be great also to have a (third) leaflet on graded exposure, goal setting and coping with flare-ups.

I've attached a version with page 2 written from a patient's perspective (ie, the kind of thing I would have found helpful to read before I came across SomaSimple).

[Diane]

Pete, I think your contribution to the pamphlet is really good. :thumbs_up

Typo in "withdrawl" .. should be "withdrawal" - otherwise, no quibbles. I like the good plain language. I like the suggestion that once the PT determines that nothing is broke the next idea is quickly and smoothly over to treating the pain itself. It explains pain but soothes fears as well. (In my own practice I determine that nothing is broke, not by painful provocation testing but just from listening and watching patients do functional test movements, long before I even touch them.)

[nari]

Pete, this is good stuff.

I think anyone at all who knows English would understand exactly what you are saying; and this is the aim of the pamphlet, after all.

Nari

[EricM]

Nice summary Pete, I like it.

[Barrett Dorko]

If I were still in the business of seeing patients I know I'd find this useful.

Instead, I asked my classes this past week to sign up for a newsletter that I'm beginning to write weekly. I got 22 to give me their email addresses and sent them to this thread this evening.

I think it's a wonderful example of this group's expertise and generosity.

[Jon Newman]

Hi Barrett,

I'm confident the readers here would be very interested in your newsletter also. What would be the easiest way to subscribe? Email you directly?

Hi all,

Let's plan on wrapping up this pamphlet by the end of the week. If anyone else has some input please contribute this week. We've had 468 views and 13 contributors at the time I wrote this--not to shabby.

Thanks.

[Barrett Dorko]

Jon,

Yes, send your email address to bldorko@bright.net and look for something each week. I'm not certain what form this will take just yet but I'm confident it will not bore you.

Jon, you're already on the list.

[Crazy Pole]

Hi again Jon,

I think it might be helpful to mention that pain is real, even if it does not originate from tissue damage. So many patients have been led to believe in the stigmatized "your pain is in your head", that this reassurance may be helpful. Perhaps it would go well in the "Did you know that pain..." section.

On the topic of universality and accuracy: is there anything in the pamphlet that is patently untrue or unsupportable and could this pamphlet live on pamphlet rack of just about any therapy department?

Although I really like what everyone has come together on, and I think Pete's pamphlet is great, I am still unsure that it won't be limited by PT's understanding of what they are working with. For those not in private practice, how many of you think that your coworkers will read this and understand/agree?

Great work so far.

Wes

[Diane]

Good point Wes, about including the "pain is real" point!

About your other point, I'm not sure what you mean by it. Do you think we should instead pander to the current level of (low) understanding of pain in our profession? Or are you just saying, most people won't get it so don't expect it to catch on like wildfire.. ?

[christophb]

Is there anyway to get a PDF of the new improved version? I can't read the word version for some reason.

Chris

[Crazy Pole]

Hi Diane,

Do you think we should instead pander to the current level of (low) understanding of pain in our profession?

Not at all.

Or are you just saying, most people won't get it so don't expect it to catch on like wildfire.. ?

More or less, yes. My concern is when a patient reads this (which they should, it's good), and then go to their PT who has mesobias (thanks for the word, Jon), then you get patients continuing to be prescribed core stabs and the like. My point is, although this handout is necessary and valuable, we may also need to consider ways to be sure that fellow PTs know this same stuff.

Someone should do a course on this stuff, or something...;)

Wes

[Barrett Dorko]

Wes,

I have the same concerns. I'm reminded of the study done indicating that patients are more easily taught the reality of neuroscience than are PTs.

I'm in my fourth year of regularly teaching this and still have no sense whatsoever that this knowledge has preceded me to any venue. Nor do I have any distinct sense that it is integrated into practice once I leave.

Still, I think this brochure is a wonderful idea. Perhaps we can point to its creation in the future and say, "See?"

[christophb]

Uh, never mind about the PDF... it helps to actually go back and read posts...

I have a question about the "you and your pain" with "Is commonly present even though all tests are negative"

Would it be beneficial to also include something how even though tests are positive, they may not be relevant to your pain?

[christophb]

Hey Barrett,
Do you want to know how many of my co-workers that attended your course regularly do simple contact? My patients appreciate you though.

Chris

[Jason Silvernail]

Here (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15322439&ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum) is the study Barrett is referencing regarding pain physiology education and PTs versus patients.

This is well worth thinking about when considering how your colleagues might take this information. I've worked with people who confidently speak to people of their disks moving about and the need to keep good posture to prevent such things.
Ugh. I can imagine what he might say if he saw this...

[Barrett Dorko]

Thanks Jason.

Chris,

78 therapists in your course in Seattle and not one ever followed through, even to lurk here, as far as I can tell.

As I say, all I can do is offer this.There's no way to force the therapy community toward sensible thought when their own thoughts remain a complete mystery, even to themselves.

[Crazy Pole]

Chris,
Would it be beneficial to also include something how even though tests are positive, they may not be relevant to your pain?
A good idea, I think. How about a blanket statement to cover both scenarios: Often, diagnostic testing is not a reliable way to predict or understand your pain. (?)

Wes

[christophb]

Wes, I like it.

Regarding presentation of this to co-workers, why not run it by them to see what they think... I'm going to show it to my manager now, see what kind of feedback/reaction I get.

Chris

[Jon Newman]

I'm going to show it to my manager now, see what kind of feedback/reaction I get.

Great idea Chris. Let us know will you?

I hope others follow your lead.

[nari]

That study caused much interest here when it was first published; but it was interest that never followed through with application of accurate pain education.
If anyone is interested, I posted the Moseley pain physiology test way back on this site. I'll hunt it out. It is designed to test both therapists' and patients' understanding of pain, and I have used it quite a bit in the past for patients.

One can lead a horse to water, and the horse will admire its reflection but not disturb the surface. Which is why I figured a while back that keeping the language as simple as possible but not reducing the concepts might be the way to go.

Nari

[christophb]

I will Jon, Barrett already offered his well wishes:D. I'll have more co-workers in the clinic tomorrow, so I'll get more feedback. My manager hasn't said anything yet, but I have a few questions waiting in anticipation of his comments.
Is this just the 1st of 3 pamphlet's? If so, the one that would be interesting to show to co-workers is the therapist's role pamphlet...


Chris

[Jon Newman]

Is this just the 1st of 3 pamphlet's? If so, the one that would be interesting to show to co-workers is the therapist's role pamphlet...--Chris

If someone wants to submit a template, go for it. I think it would decrease confusion if it were its own thread.

[Jason Silvernail]

nari-
I'd love a copy of that test. It would be great to have for a pre/post education thing at work.
It might go along with the pamphlet as well - people can show other therapists and management that these are concepts already published in the literature that are linked to good results when used with patients. I think that's a selling point of the pamphlet as well.

[nari]

Hi Jason

Go to The Good and Best Evidences>The Best Evidences>The fabulous nerve and the thread is the Moseley Test.
It is taken from his rather seminal paper in the Journal of Pain Vol 4 Issue 4 May 2003. The answers are there in the journal as well, and they are also lurking in this site, separate from the thread, but I can't find 'em.

Bernard, or Jon or Diane, can you remember where the answers are? I think they are in the mods' forum......

This test was given to about 12 PTs by a colleague of mine about 3 years ago. Only 1 answered all correctly; which I sort of expected, anyway.

Nari

[Bas]

Just a quick note: You folks have been exemplary in this design! well done.
I have just ONE (yes - only one!) suggestion: maybe the word in "Reason 3" ..."the body did not fully complete the healing(my emphasis) process" - replace "healing" with "recovery"?
The word healing indicates tissue based "damage" and I think in this stage the info should shie away from anything related to that concept.

Otherwise - generous indeed, people.

[BB]

Great suggestion Bas. I was getting hung up on that phrasing as well.

[Jon Newman]

Great input everyone. I'll try to make these modifications this evening unless someone can do it before I do. If anyone sees something else of concern, chime in.

Here's the link (http://www.somasimple.com/forums/showpost.php?p=24148&postcount=1) to what Nari is referencing.

[christophb]

I got a bit of feedback today. No disagreement in the content. People seem to feel it applies to a relatively small number of patients though. Main comment was that it would apply only if doing simple contact... ortho people are exempt from this understanding of pain apparently. Perhaps we disagree on the percentage of people who walk through the doors with an abnormal neurodynamic.


Chris

[Jon Newman]

Hi Chris,

People seem to feel it applies to a relatively small number of patients though.

This is interesting to me. There must be something in the pamphlet that lead them to this conclusion because the vast majority, if not the whole document, is speaking to non-central pain in general. For example, and perhaps this is just me, I think this information is just as pertinent to someone with an acute total knee replacement as someone with chronic low back pain.

Maybe it was the contextual influence.

[christophb]

Jon,

I completely agree, I wouldn't change anything. I think it merely reflects lack of understanding on the part of out colleagues

[Jon Newman]

Maybe something like this needs to be considered? (http://www.overcomingbias.com/2007/07/two-meanings-of.html)

[Barrett Dorko]

Chris,

A "lack of understanding"? Oh to be young and as kind as all that again.

I think it's time to look at the Alien Abduction (http://www.somasimple.com/forums/showthread.php?t=3885) thread and consider the possibility that you're trying to communicate with therapists who have already ascended into the Mothership. They no longer speak our language.

Good link Jon.

[Pete]

I got a bit of feedback today. No disagreement in the content. People seem to feel it applies to a relatively small number of patients though. Main comment was that it would apply only if doing simple contact... ortho people are exempt from this understanding of pain apparently.

This is no surprise to me. Over the past 2 years I've seen seven physios, one chiropractor and one osteopath. With the exception of the osteopath, none of them appeared to have any awareness of the concepts described in Jon's pamphlet. Or if they had the knowledge, they didn't think to share it with me.

Five of the physios hold, or are studying for, masters qualifications. Four of them teach on undergraduate courses.

[Bas]

Chris, I echo Barrett - I have listened to a teleconference about this very subject matter (Neil Pearson - well-done), and some of the questions and comments in the question-period clearly showed that some had already been taken to the mothership. And the presentation could not have been more clear and concise!

One hopeful issue: the more I present to MDs about pain-related issues, the more they seem to grasp it - more than PTs! Sad but true....I guess family docs are not quite as much stuck in a paradigm as the the abductees....

[Jon Newman]

With the exception of the osteopath, none of them appeared to have any awareness of the concepts described in Jon's pamphlet.--Pete

I just want to clarify that the idea was presented by me but the pamphlet itself is the work of those who contributed. As our knowledge of pain changes, so might the pamphlet but it seems like a pretty good start. I'll work on those recently mentioned changes tonight.

Chris,

I wonder what your collegues might add to the pamphlet that would make it appropriate for a wider audience than they imagine it to be currently focusing on.

[christophb]

A "lack of understanding"? Oh to be young and as kind as all that again.

Barrett,

I'm working on it, every day I get a bit meaner... In person my choice of words on this situation would be different. My wife unfortuanately is well aware of this.

Chris

[nari]

Bas, you are right. I have given reading material to patients and also briefly talked about it to doctors, including one specialist...and they accepted it much better than PTs.

Chris, I found that quite a few PTs thought pain physiology simply didn't apply to them (general outpatient work) and only to persistent pain patients in a pain clinic.
It illustrates a point I have made on and off for years - PTs categorise themselves into compartments. If pain involves joints and muscle, then that pain is different from CRPS, and different again from fibromyalgia and post-hemi shoulders.....and they are all treated differently.

We shouldn't change the wording. Somehow the context of the word pain has to be shunted into the Mothership.

Jon, thanks for the link. I am still not reliable with hyperlinking. One day I will get there..

Nari

[christophb]

Interesting, question Jon. Apparently when phrased like that, it does appeal to a larger audience. The content of the pamphlet wasn't questioned. Just what to do with the patients.

I've only banged my head against a wall twice today.

Chris

[jlsmithivan]

i do tend to tell pts that the pain is in their head and then go on to educate/reassure them that this is exactly where we would expect it to be and why. i have found it can defuse the fears/anxiety/stigma they often are already worrying about due to interactions with friends/family and health care systems.

[nari]

jlsmithivan,

Precisely.
The meme of 'it's all in your mind' has many connotations, none of them good, especially when dealing with workplace pain. Pain without evidence of injury is radically misunderstood. Injury is respected; its absence is suspicious.

Nari

[Jon Newman]

Here's the latest updates. Please review and add your thoughts. New contributors welcome.

[Diane]

I corrected the typo and added a sentence with a suggestion about frequency of movement.

[Crazy Pole]

It's nit-picky, I know, but I like the idea of having the line, "Your pain is real" at the top of the list. I think it sets a tone right away that might allow the person to feel more comfortable proceeding. In the end, I'm still okay if that isn't changed.

Wes

[Jon Newman]

We can do that Wes. I imagine the pamphlet will be left available to anyone to modify as they feel they need to but we'll wrap up our current productions energies this week (or at least I plan to.)

Perhaps next week we can try our luck at the pamphlet considering the PT's role if such a thing is considered desirable by anyone. As Chris noted earlier, it will be more difficult to reach a concensus with that effort.

[Diane]

I'm already rubbing my hands..

[christophb]

Yeah, that one I might be more hesitant to show my co-workers...

[Jon Newman]

Hi Chris,

Maybe someone will put their digits on the keyboard and contribute to it if you invite them.

[nari]

I think it is highly desirable.
Perhaps someone can put forward ideas on the traditional PT role as they see it in their country/workplace?

Nari

[Randy Dixon]

Well, first I think that many, if not most PT's, are going to feel slightly uneasy with the term and theme of corrective motion although most will go along with it since movement is what they are generally endorsing, secondly, under "HOW WE CAN HELP", it is written "Usually this doesn't mean lots of strengthening and stretching exercises". I think it is safe to say that most PT's think that is exactly what it means, and that is what corrective motion is.

[BB]

Hi Randy,

I think that corrective movement as it is described has been left non-descript enough that it would be safe to say anything uneasy ascribed to it will be from projection. After all, its characteristics are all that are described.

I was thinking that the characteristics of correction might make some uneasy for the same reason. If you think about their opposites: cold, stiff, difficult movement, that must be planned carefully....sounds exactly like painful movement to me. I was trying to find a way to add that, but think the pamphlet is a bit wordy already. Perhaps when the other pamphlets in the series are made this one can be subtracted from or whatever. As Jon said, it is there for everyone to modify to meet their own style.

I see your point on the strength and stretch statement. Although I think the statement is true, maybe better wording (better in that it doesn't turn away those patients and therapists who have their expectation tuned in to such things and will therefore keep them reading on) would be: "Usually this involves quick and simple movements that can be reproduced at home." or something like that.

[Bas]

The pamphlet on the PT's role will really benefit from the educational aspects of the first segments; the understanding that circulation, oxygenation and motion will help the nerves and thus the pain, makes the transition to any corrective motion much easier to grasp for the novice patient. They have just learned that A) they have a real problem, B) defensive patterns and stiffness and cold are aspects, and C) that all tissues crave easy motion. Much easier to introduce gentle stuff after this, than 10 reps of loaded squats or sustained hamstring stretches!

I have found this to be the case - all patients generally sigh in relief when I talk about what we [I]are[I], and what we are NOT going to do, and thus are more than willing - and already quite a bit more relaxed for the next steps.

The idea of gradual and gentle and natural and instinctive is not that hard a sell at all to most of my patients - I actually think that this part of their learning process is profoundly effective as attitude adjuster and stimulates more positive outlooks and mild relaxation, and thus affects the overworked adrenal system- painrelief through education. Makes the breathing awareness easier, allows trust in any hand placement, and so can impact positively on the outcome of the sessions....

I had to just ramble - I just finished writing 3 reports to the "pain" MDs here. In all 3, I was commenting on the profound effect pain education has on the patient's pain experiences - just dovetailed nicely with this thread.

[Diane]

Bas, ramble on please. Your rambling is good. Cory, I like the way you described preparing the cognitive portion of the mind in post #93. Why don't you see if you can get that in there. Take some other bit out if you have to, or condense something else.. It's a crucial bit I think.

I've been thinking lately about how it's important to treat the nervous system physically, physiologically and ph-unctionally (my new word). But it would require something a bit longer than a pamphlet, I fear...

[EricM]

I have a problem with the three reasons people have pain section. 3 reasons only? I wonder if the definition of pain might be more useful here?
As stated, point number one implies damaged tissue causes pain, which isn't always true. While there may be orthopaedic tissue damage, this occurrs in parallel with a pain experience. I think it's important to present the lay persons guide to patho-physiological reasoning here rather than pushing the patho-anatomical stuff any further.
A bit about the brain's role in processing actual or potential threat may be good too.
I'm going to get back to work on it, sometime, will post again later...

[nari]

Bas,

I keep going back to your point: ...and what we are NOT going to do

To me this is very important. There have been a lot of people who have rather grudgingly turned up in the clinic because the doc wanted them to, and come out with: " I've been to physio two or three times before, but all the exercises and pushing on bones didn't help" or words to that effect.
The problem I'm having with ideas on both pamphlets is the need for brevity, and being succinctly brief is NOT easy! Still thinking....

Nari

[Chancellor Mobley]

Hi Ya'll,

For me, it is too bad that this thread wasn't started a few months ago for I was invited by my local library to present a talk or presentation of my choosing. After some deliberation I choose to to offer a talk entiltled MOVE TO UNDERSTAND PAIN. Most of what I presented was drawn from surfing SomaSimple, Explain Pain and Science and Suffering.

My talk contained most of what is written in this pamphlet. In my talk I presented the "Three Movement Stages of Pain Response." As in Explain Pain I talked about the "Virtual Body". I see no mention of the "Virtual Body" here in the pamphelet and so I wonder if others find speaking of this helpful or not?

Chance

[Jon Newman]

Hi Chance,

I discuss the concept when it seems that the information will increase understanding.

The pamphlet is a stepping stone for people to use or modify as they desire. There will be no official stamp of approval on it from anyone. Feel free to give the folks at Soma some credit, at least for the information included in it at the latest iteration. Actually, give the researchers the credit for the information and the folks at Soma for the compilation.

Good for you on getting out there and doing some public education.