Thursday Thoughts: The Importance of Discharging People With Some Pain | Modern Manual Therapy Blog

Thursday Thoughts: The Importance of Discharging People With Some Pain

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As compassionate and empathetic clinicians, we often want to help our patients as much as possible. For many years, I thought this meant, getting them 100% pain free in 100% of their ADLs. This is not realistic and often promotes a type of nocebo effect.

If you tell a patient, you'll be 100% in 4-6 weeks, what happens when they are only 90% better, or they're left with a niggling 1/10 pain? A recent study showed that overly optimistic providers tended to

This is more true in my current cash based practice than it has ever been. I make sure to explain that
  • pain is a normal, healthy response from a protective nervous system - "Your brain is doing a great job!"
    • don't be afraid to poke the bear - Thanks to Greg Lehman for that expression
    • a little pain here and there is normal, often repeated/graded exposure to the perceived threat reduces it
    • I then explain how accommodation works to repeated stimulus - getting "used" to a cold swimming pool, not feeling your clothes shortly after putting them on
  • pain is about sensitivity - reduce the sensitivity, and preceived threat, and pain is often rapidly improved
  • pain happens, and it ends, for most, all we have to do is extend the periods when your brain feels safe by
    • repeated reset to reinforce the treatment in the clinic
    • avoidance of positions or movements that set off the alarm for enough time for the brain to feel safe
  • after 3-4 visits, you may be 80-90 (and possibly 100%) pain free, and most likely, you will keep improving, but you will most likely not need my services for regular maintenance.

Educating on the reality of pain and not having overly optimistic expectations of treatment may benefit clinicians and patients alike. You will not feel like you "failed" the patient if they are discharged with a much higher functional outcome measure score, but still have 1-2/10 pain occasion.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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