Words to sum up musculo outpt so far - notes, cancellations, dna's, notes, notes, and notes.....
I saw this patient in the first week. Prior to seeing her, i had a flick through her notes. The first thing i saw was the body chart, the whole back was basically shaded, and the legs too...... this patient has arthritis, disc degeneration, spondylisis of the lumbar spine and some more problems!
She is really a nice lady with an european accent. The first thing i said to her was "How are you?" and i think thats where it went wrong. She spent about 15mins telling me how bad her pain was, and that it was everywhere, and it's sore in the morning, and at night and during the day, and she couldn't take meds for pain because she has stomach ulcers and it sometimes drops her BP. You just couldn't win..... i felt really sorry and helpless.
Anyway, i finally managed to get a word in, though it didn't help, i just asked her specifically where her pain was. She was basically sore everywhere in her back. Any type of movement will bring on her pain, she was just ..........in pain! After chatting to my supervisor he educated me about these types of patients (chronic pain sufferers). There are yellow flags flashing everywhere. I needed to understand i couldn't get rid of her pain, next week her pain will be the same, and unfortunately, it will only get worse with age. He told me that i could only really provide some temporary relief with massage or heat pack and to maintain her mobility with general mobility exercises. And i thought physios were meant to treat people, like if someone had an ankle sprain, you do U/S, massage, PAMs etc and they get better and you fix them. But for chronic pain sufferers like my patient, it was important NOT to focus on pain and maybe even focus on more positive things such as exercises, how much more she could move in the last week and how many repetitions she could complete.
What i learnt was that we can't always "cure" everyone and not everyone will be pain free. Sometimes it's a matter of teaching and educating the patient on how to manage their pain and that's enough! I have seen other patients with similar issues since this episode and have taken the focus off pain and tried to focus on more positive aspects of their life. If you do that, the treatment session will run much more smoothly and you'll finish on time!
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I agree!! I'm also on my musculo out-patients prac and we get quite a number of referrals from tertiary hospitals with people with chronic pain. It's hard at first to accept the fact that we can't actually cure them and we know that they're going to come back week after week witht he same level of pain.
I got a bit frustrated the first few times because I guess I thought that if their pain wasn't going to change then why come to physio??! I've since realised that some patients enjoy the short-term relief we provide and some of the management strategies do actually help....not to mention the social chat that they manage to squeeze in!!
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