nari
03-02-2005, 11:51 AM
This is one remarkable woman...
Late fifties, established 2 weeks ago a reputation with our centre staff as being arrogant and rude.
Presented with a 20+ year history of shoulder pain (bilateral, unilateral, all points in between) and spinal pain (all points in between). Several episodes of previous physiotherapy which was concentrated on stretches, strengthening, etc etc. Pain steadily increased and she told them all where to go...and the pain settled, characteristically, on the right side, from the head all the way to her foot; non-dermatomal, non-specific, allodynia, cold, hot, prickling, numb in parts, until she felt quite split down the middle (her words). Left side normal.
Refused medications except for the occasional panadeine forte when things became overwhelming.
Social history - orphaned by the age of ten, with both parents dying of pneumonia about two years apart. Lived in various orphanages, reported being treated badly, abuse of all kinds. Disastrous marriage, children in contact but not close. Lives alone.
Initially, defensive, concentrating on pain, distressed, angry (the eyes have it!) but willing to talk through her story. Not hostile towards me.
First session, education on central sensitisation and the usual pain stuff.
Later, O/E: ROM of (R)shoulder limited by pain, as with cervical spine, lumbar spine and SLR. No passive testing done, all active.
ULNTT results were all over the place but provoked pain in the shoulder, elbow, wrist and "carpal tunnel".
She was fascinated by the concept of pain originating in the brain, and not dancing around all her bits and pieces willy-nilly. Took the whole concept on board easily; and admitted she has been practising Buddhism for some years and this all fitted with her ideas on that religion.
I gave her movements based on the ULNTTs, including my 'Buddha' movement which she obviously took a liking to!!
When she realised this pain was not necessary, within a week all pain in her spine had gone. She explained that she told herself 'my spine has no pain, it is just stiff' and that was that. Her (R) shoulder was still a bother.
Her (R) arm was negative on all testing today - the third visit. When it provoked pain in various sites, she said: 'That doesn't matter, it's normal'.
(I had told her that pain on full testing anyway was normal).
She devoured the literature I had given her - the Moseley test for knowledge about pain physiology, my own stuff I have written out, etc.
On the test, she did fairly well (50%) correct, but had done it before reading the information.
She still felt split down the middle; but it didn't concern her. Her entire demeanour had changed; and when I asked her why this had happened, she replied that she had now some control over her 'existence' and what she felt/experienced.
It was the only bright light in a dismal day!
Moseley is so right in his insistence that pain physiology education is critical...
nari
Late fifties, established 2 weeks ago a reputation with our centre staff as being arrogant and rude.
Presented with a 20+ year history of shoulder pain (bilateral, unilateral, all points in between) and spinal pain (all points in between). Several episodes of previous physiotherapy which was concentrated on stretches, strengthening, etc etc. Pain steadily increased and she told them all where to go...and the pain settled, characteristically, on the right side, from the head all the way to her foot; non-dermatomal, non-specific, allodynia, cold, hot, prickling, numb in parts, until she felt quite split down the middle (her words). Left side normal.
Refused medications except for the occasional panadeine forte when things became overwhelming.
Social history - orphaned by the age of ten, with both parents dying of pneumonia about two years apart. Lived in various orphanages, reported being treated badly, abuse of all kinds. Disastrous marriage, children in contact but not close. Lives alone.
Initially, defensive, concentrating on pain, distressed, angry (the eyes have it!) but willing to talk through her story. Not hostile towards me.
First session, education on central sensitisation and the usual pain stuff.
Later, O/E: ROM of (R)shoulder limited by pain, as with cervical spine, lumbar spine and SLR. No passive testing done, all active.
ULNTT results were all over the place but provoked pain in the shoulder, elbow, wrist and "carpal tunnel".
She was fascinated by the concept of pain originating in the brain, and not dancing around all her bits and pieces willy-nilly. Took the whole concept on board easily; and admitted she has been practising Buddhism for some years and this all fitted with her ideas on that religion.
I gave her movements based on the ULNTTs, including my 'Buddha' movement which she obviously took a liking to!!
When she realised this pain was not necessary, within a week all pain in her spine had gone. She explained that she told herself 'my spine has no pain, it is just stiff' and that was that. Her (R) shoulder was still a bother.
Her (R) arm was negative on all testing today - the third visit. When it provoked pain in various sites, she said: 'That doesn't matter, it's normal'.
(I had told her that pain on full testing anyway was normal).
She devoured the literature I had given her - the Moseley test for knowledge about pain physiology, my own stuff I have written out, etc.
On the test, she did fairly well (50%) correct, but had done it before reading the information.
She still felt split down the middle; but it didn't concern her. Her entire demeanour had changed; and when I asked her why this had happened, she replied that she had now some control over her 'existence' and what she felt/experienced.
It was the only bright light in a dismal day!
Moseley is so right in his insistence that pain physiology education is critical...
nari