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
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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
Pain is like the wind.
It can only be viewed by its interface with the environment.
We see the trees move, the leaves rustle, the flower petals quiver. We see the thick dust in the air, the yard furniture toppling in a pile by the fence, the branches dropping to the street.
Our skin turns alive with an unseen pressure. We are urged to move to the left by an unseen force from the right. It blew my hat off.
“I cannot take a picture of the wind. I can show you a picture of a windy day… but not the wind.” Continue reading
I was getting sick. Ugh. I was able to hold off long enough to finish my caseload, but once I was home, I let my resistance to the bug go. My clinical crew knew I wasn’t feeling well, but I thought I’d be back by the next day.
Next morning: nope. I needed to stay home. I tell my wife I’ll be staying home as she leaves for work, “s’all good, honey.”
So I call in to the clinic to let them know. When they answer the phone my voice changes a bit ( I notice retrospectively). I explain I’m worse *cough*, and thank them for arranging the schedule to cover me *cough*. Then hang up.
What was that about? I ask myself. I was not sure that I sounded sick, or did I? Did I just throw in an extra throat-clear for emphasis? I realized that I felt a strong urge to sound sick, to “sell” that I wasn’t feeling well. My sickness was the truth. Yet, I was pulled very strongly to embellish it in my short 30 second interaction… hmmm.
The purpose of communication is often to get a point across to some audience outside of yourself. You express yourself so others will know what you mean, how you feel, why you think, etc. Continue reading
Some things in life are definite. Some are definitely not. And some are somewhere in between.
Same goes in healthcare and medicine. When you see a hyperactive deep tendon reflex or produce an upper motor neuron sign via Babinski or Hoffmann’s, its pretty obvious. Usually, there isn’t much debate about its existence. There may be some back and forth about the degree to which it exists or to its implications; but, again, most parties will agree “that just happened.”
Same goes for an infected wound. One look, maybe one smell, most people can agree about the degree of bacterial colonization (i.e. infection or no). We can take this further with abnormal heart sounds, clubbing of the digits (indicative of lung/heart disease), or yellowing of the sclera indicating jaundice. The list can go on, but it doesn’t need to. There are a host of objective signs that indicate the presence of disease or pathology. We can even go further with laboratory diagnostics and imaging studies to attempt to confirm or rule out suspicions about the presence of a disease processes.
We have quite a body of information and resources at our disposal when trying to figure out what is wrong with the patient sitting before us. Even more than that, we have gained enough knowledge to decipher and utilize people’s reported symptoms, their subjective report, to aid in this process. As fraught with bias and inaccuracy as an individual’s own perception of their situation could be, we still have found ways to weed through the minutiae and find bits of key detail that aid in the diagnostic process. It could be how long their symptoms have been present, or what activities exacerbate their symptoms. You might ask, “Do you have any popping or clicking? Or feelings of instability?” Or if the patient reports numbness or tingling in a certain area. All of these details paint a little more of the broad picture of the patient’s condition. And one of the most helpful details when painting that picture Continue reading
People say it all the time: “Oh, it’s gonna rain, I can tell in my knee” or “My knees really hurt over the weekend… they do that with bad weather.” What is it with these magical knees? From my personal vantage point, there is no logic to this… it’s simply psychological mis-attribution of causes… but it is heard so often, is there something to it?
Well, I asked on Twitter and fully enjoyed the convos that occurred…
So here is a summary of what was shared: Continue reading
We need to keep in mind that there is no pain signal coming in from the periphery.
Pain is not an input. It is simply (and complexly?!) a nerve being stimulated, sending an action potential up to the spinal cord and then brain, where the brain interprets those signals.
…and that’s where it get’s sticky… because what is Continue reading
In reading Spencer’s recent posts (particularly Part 2, but also Part 1) I am struck by an interesting theme. The information was there. It was just somehow interpreted wrong and dispersed wrong, or received wrong… like a game of telephone.
Spencer mentions that the IASP definition of pain “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” is clearly presented in education. Since it is there all along… how does it get lost in translation? Can we blame the Continue reading
And you’d be surprised… the answer goes further back than you might think.
So if you read Part 1, we left with a series of questions — all boiling around the conundrum of what I will call “the pain education lag.” This can be defined as the time it takes for the education to take an effect (i.e. reduction of aberrant pain). Essentially, you provide a treatment, but it’s possible for no effect to be seen immediately (and its also highly likely for this to occur in such a delayed fashion). And this is something that is significant. Other treatment effects take place immediately. Yet, with pain education Continue reading
Remember when you first began practice? Patients came to you for help. You were the solution to their pain..or were you?? Admittedly, you might have been a little scared…not entirely sure of how to deal with your first complex patient of the day. He had chronic LBP for the past 8 years…heck maybe for the past Continue reading