Dear Scott
Is it possible to have psychosocial problems because of a physiological
condition or must the former precursor the latter. Ie, can chronic pain,
dysfunction and lack of sleep cause depression, relationship difficulties
and break up, job problems and loss or do the others happen because of the
other?
I believe that each can cause the other and differentiation is tremendously
difficult. How do we know if our patients simply have not been treat
properly for their problem or that it is pychosocially driven. I would urge
all to exercise extreme caution prior to making pyschological judgments with
regard to their patients for two reasons. 1 PT's rarely have the training 2
pyschological diagnosis is by no means fool proof.
Be careful of the Cyriax reasoning flaw, 'I have done my tests, the patient
does not fall into any cateogory I know, therefore they are bonkers in the
head (pyschogenic pain)'. The traditional opt out of poor physios
everywhere, rather than say simply say 'this is too complex for me'. Lets
not go the way of the doctors, ie I will make a diagnosis in every ocassion,
regardless of the accuracy.
As a wise old pyschologist once told me ' never open a can of worms you can
not close again'.
I am not anti pyschosocial, I just think it is way over diagnosed. I have
got great results with chronic fibromyagias, whatever that means, with
manual therapy, but sure some people are behaviourally driven.
Finally all pain is psychological, it has to be appreciated in the CNS, we
are discussing the triggers.
Come on Ian Stevens this must stir you out of your scottish malt
stupification !. Yes I am getting playful, no I haven't had a drink.
Kevin Reese PT UK
----- Original Message -----
From: Scott Epsley <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, August 14, 2001 2:28 PM
Subject: Re: what is wrong with psychogenic pain??
> Henry,
> How are you mate. Good to talk again. I think you are learning very
rapidly!!
> You are, in my opinion (and others may differ) absolutely correct. People
have this impression that pain is 90% physiological and 10% psychological.
I would suggest is it more the other way around in some instances - well
many infact.
>
> I wonder if anyone has observed the social status of many patients with
these syndromes. I have. It seems that many have had major family traumas
such as deaths, abuse, divorce etc. that frequently they have not resolved.
How did I find that out? Well, I listen intently to everything my patients
tell me, and then I guide the conversation to allow them to voluntarily
expand if they wish. It's amazing how people talk about what is on their
mind. This will often reveal an underlying anxiety. In saying that is has
been suggested that FM or CFS are viral induced. I don't think there is any
proof either way. I doubt that it is all psychological. I think perhaps
the condition is physiological but its severity is psychological.
> ---
> Scott Epsley
> BPhty., MAPA, SPG.
> PRINCIPAL PHYSIOTHERAPIST
> Clifford Chambers Sports Medicine
> Suite 4, 120 Russell Street
> Toowoomba QLD 4350
> Australia
>
> e-mail: [log in to unmask]
>
>
> On Mon, 13 Aug 2001 20:59:11
> Henry Tsao wrote:
> >To all:
> >
> >I was talking to another Physiotherapist today about an article I read in
> >Postgraduate Medicine by Hadler entitled "Fibromyalgia, chronic fatigue,
and
> >other iatrogenic diagnostic algorithms - Do some labels escalate illness
in
> >vulnerable patients?" The article stated that syndromes such as
fibromyalgia
> >might primarily be psychogenic. I thought that was a fair statement bound
> >for controversy, and it definitely caused this other Physiotherapist
> >inferring that fibromyalgia and CFS were purely psychogenic pain. He was
> >quite insulted and angry since his wife has CFS, and he thought I was
saying
> >his wife "made up her symptoms."
> >
> >I knew the above was more of a communication error between myself and
this
> >other Physiotherapist. However while I was driving home, I thought to
> >myself, what is wrong with psychogenic pain? In essence, pain is a very
> >subjective experience and an element of mental processing must be
involved.
> >Why is there a kind of stigma towards psychogenic pain? Why do people
feel
> >insulted or offended through the pure mentioning of this "p" word?
> >Psychogenic pain almost has similar "offending power" as the word placebo
> >(and notice how they all start with the letter "p").
> >
> >All I have are questions: Is it simply the word psychogenic, meaning
> >generated from the mind? Is it that we under the medical model are so
> >focused on finding the source of the pain, the issues in the tissues,
that
> >we have ignored the contributing psychosocial factors? Is it that
> >psychogenic pain comes with the labels such as crazy, demented and
> >hypochondriac? Or is it that with the rapid increase of litigation and
work
> >related injuries, to have "pain coming from the mind" is viewed as being
a
> >fake, a fraud, somebody who is just there for the money?
> >
> >any thoughts or comments??
> >
> >Henry***
> >
> >
> >_________________________________________________________________
> >Get your FREE download of MSN Explorer at
http://explorer.msn.com/intl.asp
> >
>
>
> Get 250 color business cards for FREE!
> http://businesscards.lycos.com/vp/fastpath/
|