The Perfect Pain Patient?

[vikram]

Jason,

Perfect pain post!! :thumbs_up

Perfect example of where we go wrong sometimes with the idiosyncracies of managing pain. We do tend to ignore pain in the sense that we can "measure" it, treat offending 'causes', real or imaginary, and still discover with surprise that it's there, despite traditional approaches which "work" for some patients.

Approach? My first instinct is Simple Contact..she sounds ideal for it. Criteria? Quite likely an abnormal neurodynamic...

I might let Barrett answer that one...

But, in the days of pre-Simple Contact, I would have:

Looked at Yellow Flags, for the purpose of possibly understanding why she is in this situation....may not be relevant, but often is.

Tested for Slump, SLR, ULNT1,2,3,4. Likely to be positive.

Treat with the testing procedures...carefully...
AND, simultaneously:
Educate++ on the origin of this pain, its physiology and behaviour under various circumstances (eg, when lying down, trying to sleep)
Especially emphasise that this pain cannot HARM her, physically.

Do a Moseley test (I think that is around somewhere on the BB, if not, can post it) to test the level of understanding as the result of education. This is for her benefit, not mine.

Tell her to go and do whatever she wants to do - and that is anything at all -and help her get there. (However, if she aims to go climbing Mt Rainier, I would encourage a more realistic goal).

See her only once a week or fortnight, giving her food for thought and time to digest, without 'interference' from me.

I wouldn't touch vertebrae or muscle. Soft tissue work (especially the kind that Diane does) may help in my attempt to talk to her CNS.

Question: What sort of language does she use when describing her pain?

More later


Nari

Thanks for posting this Jason, and you're welcome for earlier provision of any bits of virtual conversation that you may have read/felt that came to you from me.

Isn't it classic that all her practitioners declared her better by measuring some observable thing about her, but ignored her complaint? (Sound of me ripping out my hair.)

Kierkegaard said, "The majority of men are subjective towards themselves and objective towards all others - terribly objective sometimes - but the real task is in fact to be objective towards oneself and subjective toward all others." I think that's awfully good advice for therapists. Time to enter the woman's "movie" or narrative with her, and start to look for clues with some attentive resonance (see Cells and Stars for what that is).

Simple contact, like Nari said, would be a great tool, something she could work on herself.

Unlike Barrett, who finds it a nice way to hold a boundary between himself and his patients, I've found that on the contrary, it ends up opening up people and their stories quite rapidly, moreso and faster sometimes than I feel I have the capacity right now (winter) to handle. So I use it sparingly for people, saving it for ones who I could describe exactly the way you've described your gal.

What color car is she driving? Okay, just kidding.

The physiologic signature of neural irritation is sympathetic dominance, so I'm wondering whether or not your patient is commonly cold. This might be related to her breathing pattern as well.

I'm also wondering about the resting posture of her legs when she lies supine. What you see in the photo linked below is what I look at. When the nervous tissue is pulled tautly (for lack of a better term), what you might find is relative internal rotation and/or adduction in the hips, usually the more symptomatic side is easily seen to be more adducted and the toes point toward the ceiling. This is derived from Breig's work published in "Spine" a few years ago. The second link demonstrates the position more commonly seen in right sided pain.

http://www.flickr.com/tools/uploader...e?ids=79939335,


http://www.flickr.com/tools/uploader...e?ids=79940389,

Hi this is my first post here. I'm not a professional in the field - unless you consider the patient a professional at pain management! I'm only 23 years old but have spent a life time on the computer, and I'm sure that time I fell out of the tree a few years ago didn't help at all. Barrett, the first picture you posted is me. My head is pulled more tautly to the left, down my neck, and down the spine and under the shoulder blade, and I have stiff T-spine and stuck ribs (it feels like, because I can't breathe through this left segment of my back). My torso is slightly twisted as is my pelvis, and of course my right leg is rotated outwards like in the picture.

Obviously I dont expect you to diagnose or cure me online, but I guess what I'm asking is - where the heck can I meet folks like you to treat me!! I'm stuck out here in Champaign, IL because this is where I go to school, and I would do anything to feel better (pain, limited range of motion, lots of stiffness). I'm too young for this You folks seem a lot smarter than many professionals I've seen, and I suspect you're on to something with this whole nervous system thing!