One of the first tasks given to students on clinical rotation is to come up with an exercise flowsheet, or plan, for a patient they have just evaluated. This seems pretty standard in the outpatient orthopedic setting for students.
This task is often hard enough for many students. They work through it and I question their decisions and ask why they picked a certain movement. It’s harder than it sounds to predict how things will go and what they should work on. I always let them work on this independently at first, then we discuss their thought processes.
I’ve started using a Three Question Test for each item on the flowsheet. I’m not sure this originated with me, as I have been mentored by many and have picked up ideas from lots of smart folks. But here is the current question sequence: Continue reading →
I’ve have a handful of “Go-To” videos I share with people when I want to get them up to speed on pain science topics. Recently there have been a few more videos surfacing, and I wanted to place them here in a post for you, in-case you want some updated material, or new concepts.
When people ask “why does it hurt?” I’ll get around to stating that “… also, context of [your pain] is a factor in how it feels.”
Now this may make sense to you, the PTBT audience, but this is often not an idea that people have thought of. Most people only remember a politician saying his/her words were “taken out of context” so it may be important to explain context.
Here are two quick context stories I tell. Please use them, please make them your own…
1.) Context example… “So now let’s say you are walking in a spooky forest, it’s dark out, you’re by yourself, a bit creeped out and you feel this on your shoulder (lightly tickle the skin), what would your reaction be?” Often a patient will exaggerate looking back quickly or state “I would jump, think it was a spider or something”, etc. Continue reading →
In walks your 2pm evaluation. Well, not really…they scoot in backwards, sitting on their four-wheeled walker complaining about how long the medical history form is and “why do you need to know all that stuff?” A long past medical history is fine, you can handle that, you can synthesize how 10 years of uncontrolled diabetes mixes with COPD, a back problem they’ve had “since they were 19” and the multiple progressive knee scopes and procedures they’ve had.
During the interaction, however, the person is “off.” They don’t interact with the ease and simplicity that you do with your staff, your friends or the prior patient. You can’t quite describe it well. Continue reading →
If a tree falls in the forest, and no one is around to hear it, does it make a sound?
Ah yes, a classic riddle indeed and one I will answer. No. It does not make a sound. Let’s explore this, and how it relates to understanding pain and sensation.
First we will define a sound. The English Oxford dictionary defines it as “Vibrations that travel through the air or another medium and can be heard when they reach a person’s or animal’s ear.” You need both waves and an ear to complete the “hear.” So in our above riddle, there is no hear of the sound due to there being no person’s ear in the riddle, as it is in the definition. Continue reading →
N=1 has turned into a symbol, a representation meaning to treat a person as an individual, as a unique complex being that has personal factors and history that make them who they are. (see the mountain stream analogy via Aaron Swanson.) When we speak about treating the person in front of us we can say “N=1.”
This is being championed by many groups. The “Pain Science crowd” certainly incorporates individualism and biopsychosocial constructs. Cause Health is bringing awareness, and I’ll also recommend Neil Maltby’s blog: Becoming More Human. Continue reading →
There’s gotta be a reason. You can’t have an event pass by you without knowing why, right? Right.
“Well, you know, the weather made it hurt. It’s all that rain…”
“My back is hurting today, I was at a family BBQ and I stood for an hour yesterday, so…”
“The knee feels much better, I think it was the tape you put on there.”
Post Hoc Ergo Proctor Hoc. After that, therefor because of that.
Making a reason for things is not conscious, often. We always see cause and effect as a truth. If we’re wrong, it’s confabulation, not a lie. It’s “only human.” See a quote below from some of the Split Brain research: Continue reading →
One of the most real, shared experiences that we have as humans is non-existent in the true sense of cause-and-effect reality. The sense of wetness.
There is no “wet receptor” or nerve fiber type devoted to the sensation of wetness. No indeed. Insects have “humidity receptors” but we lack the ability to feel the water that so defines our planet. The human sensation of wetness is the complex, near magical (if you don’t mind me saying so) confluence of pressure change, light touch change, motion direction, speed and pattern, temperature change, and visual input. Continue reading →
Allow me to make the case to discuss modern* pain science views with all who will listen, importantly, people who are NOT in pain.
There seems to be support for pre-operative pain education as an effective intervention. Studies have shown improved surgical experience and reduced health care utilization (1), improved short term pain reporting, quicker return to activities and utilization of nonpharmalogical pain management strategies (2). Long term pain outcomes are not significantly effected (that I could find), but it certainly helps the patient in meaningful way (3). Continue reading →
There is no such thing as Time Management. There is only Self Management, time goes on as it will, no matter your intentions for it.
So what can happen over time? Time is one of these factors that is hard to account for, but does a lot of the treating of a patient for you. (see: It’s not ALL about you). The biology of tissue healing occurs over a timeline and it occurs at a pace that is affected, but not determined, by us or your patient. Continue reading →