Dear Di,
Sorry I didn't read your message before replying, but "my sentiments
exactly"!!!.
scott.
--

On Sun, 05 Mar 2000 10:09:13   acthydro1 wrote:
>
>
>
>> Jill & Kevin
>>
>> I agree completely!  Why is it only for the spine that chronic pain or
>> patients that don't seem to improve immediately as a result of our treatment
>> that we automatically assume that it must be psychological?
>
>>> Jill, I think that you've missed the boat here. It is widely accepted that
>approximately 90% of people presenting with spinal pain will improve within 2 -
>6 weeks. The types of patients that do not improve (ie have chronic spinal
>pain), I think can basically be divided into two groups.
>
>1.    The group who over time have increasing difficulty "coping" with the
>constant pain and as a result of this pyscho-social factors play an important
>part in pain management and learning to deal with the condition ie:
> problems due to a change of roles in the relationship; feelings of reduced
>self-esteem due to not being able to carry out their normal role in family life
>whether that be caring for the family or as primary income earner; societal
>pressures or perceived pressures. These feelings of anger; depression and
>withdrawal can have a very real effect on central processing areas (Central
>sensitisation refer D. Butler) and pain perception.
>
>2.    The group who have had psychosocial factors pre-existing in their lives eg
>past history of depression; problems with teenage children; hate their jobs;
>financial pressures; unhappy marriages ...and the list goes on...
>
>I thinK that if you look carefully at those patients of yours presenting with
>chronic pain (of any desription ie spinal or otherwise)..you will find that
>these issues are either there or becoming increasingly prevalent. I do not think
>that anyone is saying that they have a "psychological" problem meaning that it
>is all in their heads and yes they do require our skills as Physiotherapists but
>we also have the opportunity to talk to them about how other things affect pain
>perception and how it is important that if there are other issues that they
>think may be affecting their ability to cope that they would be better to talk
>to someone who is qualified in this area.
>
>This is an important part of taking control and "ownership" of their condition
>and moving to an acceptance that there are things that they can do to assist
>making their lives more manageable.
>
>
>> We know very
>> little about the spine, so instead of trying other treatment methods or
>> referring the patient to another practitioner who may try another approach,
>> we automatically lay the blame to the patient, i.e. not compliant, is under
>> too much stress, isn't following PT's advice, or has some underlying
>> psychological issues that must be addressed.  Could it be (dare I say it)
>> that we tend to say anything to our patients except the truth- maybe we
>> don't exactly know what's going on, why they're not responding to our
>> treatment, that maybe we just don't know?
>
>It is important not to blame the patient and I do not think that the majority of
>physios that truly understand and work with chronic pain patients would ever do
>that!
>
>>
>>  As physiotherapists (speaking from my perspective), we are not pop
>> psychologists and should not let psychological issues be in the forefront of
>> our minds every time we evaluate a new back
>> patient just because they're back patients.
>
>No we are not psychologists but we are often in a position where we can identify
>if there are other issues going on that may be affecting these patients coping
>mechanisms because we spend a lot more time with them than their doctors and we
>have an important role in assisting with this by referring on if necessary or
>bringing it to the attention of the patient and their GP. (It is very important
>when discussing issues like this that the patient understands the link between
>extrinsic factors (ie psychosocial) and intrinsic factors (their injury and
>processing areas)
>
>> ?  If we're so fast to jump to non-mechanical
>> conclusions, we could easily miss many of these problems (I know firsthand
>> that this happens).
>
>This is a tricky one...the nature of spinal pain is so complicated that often a
>"mechanical cause" cannot be found and even if it can eg bulges on MRI, may not
>necessarily be related to injury. I know that the majority of patients that I
>see are of the Non-specifc variety. It is likewise in these situations to ensure
>that we use our skills to assist the patients to understand that back pain is
>very complicated and can involve many strucures and just because a "cause"
>cannot be found that it does not necessarily exist.
>
>>
>> How many patients with other pathologies at other joints do we treat,
>> knowing the patient is fairly non-compliant & has other issues, etc, and yet
>> our patient still gets better?  This should tell us something.
>
>Yes it tells us that they probably would have got better anyway ie part of the
>large percentage that do with our intervention and there probably wasn't a large
>neurogenic component to their problem.
>
>Please have a read of David Butlers; MOBILISATION OF THE NERVOUS SYSTEM if you
>want more technical info. Research is continuing and physios are at the cutting
>edge. How about getting on board!
>
>All the best
>
>Di Howell
>Physiotherapist
>Canberra
>Australia
>


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