You've often read my standard "Your complaints just flared up? Great news! Rapid onset normally equals rapid resolution. It's a good thing you came in so quickly!"
Here are two more ways to motivate a patient during a flareup and prevent catastrophization
Scenario 1: Assuming a patient has progressed, and especially rapid responding after several visits, then they worsen for whatever reason....
"Don't worry, if you had pain for a much longer time, and we still improved you rapidly, there is usually no reason why we can't just do it again!"
- unless there is actual physical trauma, an exacerbation can normally be dealt with rapidly
- instruct them to double down on their MDT based HEP if they flare up and if there is no effect, give it some time
- if in 1 day it does not rapidly improve with HEP/rest, call and we'll get you in ASAP
Scenario 2: If it was a patient who already been through step 1, or just did their HEP and/or rested appropriately and they came in better than the flareup
"This has been a great test of how well you're improving! Prior to PT and education, your flareups would last -insert longer time here- Now, it only lasted 1-2 days and you're already getting closer to the baseline prior to the flare up. Great job!"
- any regression after improvement is worrisome for most patients
- it's also part of our job to encourage and provide realistic expectations
- part of those expectations are knowing how much is "too much too soon," or don't give on the HEP too early
- it just happened today when a chronic pain patient had flared up after shovelling some lovely Buffalo, NY snow
- at first she was going to call and try to get in, instead she located some spots along cervical patterns that I normally worked on, had her husband press on them
- by the time she came back, her arm pain was centralized, and she was almost back to baseline
- she said, "Instead of freaking out, I just tried what you normally do to me."
- I often describe some patient's ups and downs on a visual graph
- "You have ups and downs, but if we drew a graph plotting them, it would go steadily upward, indicating overall improvement."
Now go out there and ease some anxiety!
Keeping it Eclectic...