I am currently on a musculo prac and have a patient who has chronic back pain. I find treating patients with back pain a complete mystery. Some how the manual techniques we learnt at uni does not seem to produce much relief for chronic conditions. Upon giving up all hope, she is now attending physiotherapy as a last resort based purely on the fact that she has been referred by her doctor. And, she has no expectations for the therapy at all. She had a pain score of a constant 8 out of 10 in her LB. She looked tired, worn out and any slight sense of hope has been removed from her frail body. She also displayed a stressed out mood, was very lethargic and seemed frustrated with her work situation as she is a car detailer which would involve a lot of bending and twisting.
Even though some professionals regard EPA as an alternative treatment, I believe in this situation EPA worked very well for her. Upon consulting my supervisor and clearing any contraindications related to using TENS, we decided to try TENS on her. After the applications of TENS on the patient, her back pain had reduced to 2 out of 10. Since it had produced such good results, we decided to see her 2 days later and did TENS on her again. She was also impressed with the outcome of the treatment and voiced her relief.
This made me feel nervous yet excited at the same time as I had never done TENS on a patient before. This has thought me that as a physio, we encounter various conditions and technique outcomes vary patient to patient. We should not be afraid of venturing into the different modalities and techniques.
It is also important to understand what the patient is going through especially with this patient who has absolutely no hope of recovering. It is essential to have patience with this patient because she might be reluctant to try various therapies especially TENS. The ability to effectively deal with patients will come with time and practice.
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3 comments:
I've just finidhed my musculo prac and I'm still yet to use TENS on a patient. It's good to hear that it actually works.
I guess it depends quite a lot as to what your supervisor prefers and what they believe works in each case as it presents. I had a lady with shoulder pain who was extremely limited in all movements by pain and I was thinking about using TENS on her. But somehow I was convinceed otherwise. I realise that you have to base it on a case by case basis but I'm really glad to hear that TENS was effective for your lady. I realise that TENS by itself may not constitute Rx but i think it's a useful conjunct in many cases.
Yeah im in the same boat as mel with this one; I also just had a musculo prac and i didnt use TENS either. I had pt's similar to the one you have described Gaya, and although TENS was mentioned as a possibility, we never actually followed through. My supervisor was much more keen on manual techniques and because the pt's were making progress, although slow, i think it warranted continuation of these. I think TENS would have been used if this had not been the case. TENS could have been used to increase progress, but i guess we'll never know haha. After your post i will definately keep it in the back of my mind, and not just to be used as an absolute last resort.Thanks
I find chronic pain patient so difficult too! A great thing I learnt when I was on musculo is that its good to not focus on pain with a chronic pain patient but focus on more functional things as an asterix. For example the pt may present with 8/10 pain day 1 and only able to stand for 5 min. After weeks of treatment the patient my still have 8/10 pain but is now able to stand for 20 min. If you focus on pain the patient hasnt improved but if you focus on sumthing functional eg stnding then the patient hs improved greatly!
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