Explaining Pain over the Internet! | Modern Manual Therapy Blog

Explaining Pain over the Internet!



Other than creating a positive, education, and warm atmosphere, I like to use metaphors to help patients understand their condition and to decrease the perceived threat.

I did a google plus hangout video consultation over the weekend.  The patient sought me out after looking for help for his thoracic spine on youtube.

MDT can be done without ever laying your hands on anyone, so it's a natural evaluation and treatment, that requires mostly education and getting the patient to move in the right direction to alleviate their complaints. There were a few strikes he had against him. The first one was that his dad is one of the most prominent radiologists in the large metropolitan area he lives in. So he had a history of a large disc protrusion in his lumbar spine as well as “several” disc protrusions in his thoracic spine around the area of his pain and paraesthesia.

His complaints started 10 years ago, insidious onset of lumbar and radiating leg pain. It occurred after he used to fall asleep on his job almost daily in a very flexed position in his chair. He did say he has grown up a lot since then! After seeing the “sea of endless practitioners” he did find one thing that helped, the Treat Your Own Back text by none other than McKenzie. He was able to centralize and abolish most of his “chronic” lower back and radiating leg pain. He was not able to treat his thoracic pain and paraesthesia.

Here are the education pieces I conveyed to him regarding his “chronic disc issues for 10 years”
  • when you take a large population of people off of the street with have no symptoms, up to 80% of them have positive radiological findings, some which appear to be worse than yours
  • when you do not have your complaints, your MRI still shows the same findings
  • much of what those findings are just the kisses of time – from David Butler
  • each educational piece slowly turned on the light bulb, but it was flickering due to all the thought viruses he has heard over the years
  • when he mentioned his chronic disc issues for 10 years again on the follow up my response was
    • if you skinned your knee repeatedly 5-6 times over the past 10 years, do you tell people that you have a chronically skinned knee
    • DING! The lightbulb really went off then

In terms of MDT findings, we were able to produce his complaints with some cervical protrusion and they were also easily centralized and abolished with cervical retraction with extension. When I followed up with him then next day, he was moving out of his apartment, but felt much more positive about his pain. His leg pain returned, but I told him to offset the repeated lifting and bending with hips offset pressups more often taking frequent breaks. Since then he has golfed pain free!

What are some of your favorite patient explanations and metaphors to decrease the perceived threat?

4 comments:

  1. I like this video

    http://www.youtube.com/watch?v=4b8oB757DKc

    Which I will often get patients to watch

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  2. Jon, I normally refer my pts to that one as well. So well done!

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  3. Thanks for sharing this Dr. E! Great story and even though PT separates itself as being hands on and 'with' the patient...this online consultation makes you think of what the future can bring...

    Nevertheless, I just use the term 'wiggle room' when explaining pain. I actually draw on my whiteboard using the cartesian plane (with x and y axis) and say when we are young, we are up in the "Positive" a whole lot as we are active, not a whole lot of repetitions activity, more flexible, etc. but as we get older, get stuck in our ways, decrease exercise and have poorer diet, repetition of job, driving, stress, etc.; we tend to slowly lower across the "X" or "negative" axis and this formulates the firing threshold and boom, we have pain. And until we make a change, this wiggle room decreases (so we can't sit or stand or walk as long as we used to) and we need to increase this space.
    I hope this makes sense (it seems to when I draw it!), but then I say with specific exercise, manual therapy to reset, etc, etc.; we can bring ourselves back up to the positive.

    I also show the video of that too Jon...really works well. I also use the one initially I saw from EIM about MRI false positives.

    Hv

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  4. I've heard similar explanations from Stanley Paris and summation, explaining why you should Tx for regional interdependence and the whole being greater than the sum of its parts. Your avatar should be you and your whiteboard!

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