Scott and Kevin,
I don't think we are qualified to diagnose psychosocial problems, but we
should be able to recognize these factors that may impede the patient's
recovery. I agree when Kevin states that "I believe that each can cause the
other and differentiation is tremendously difficult." However, psychogenic
pain does not equal "bonkers in the head," and that was the point of my
post.
I remember talking to an experienced Physiotherapist who worked in a pain
clinic. He stated that Physiotherapists are in the best position for
treating chronic pain, because we already have a good sense of touch and
handling skills, we have good communication skills, good clinical reasoning
skills... all we need is to understand more on psychosocial factors and on
the processes of pain. I think this is the challenge for our profession in
the near future... how to incorporate psychosocial factors with our
treatment. How do I tell my patient who complains that "their disc pain has
not healed even after a year" that the pain may not be entirely tissue
oriented, without the person thinking "so you are saying it is all in my
mind."
Thank you for all your responses... it was interesting reading them.
Henry***
>From: "k.reese" <[log in to unmask]>
>Reply-To: - for physiotherapists in education and practice
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: what is wrong with psychogenic pain??
>Date: Tue, 14 Aug 2001 19:03:09 +0100
>
>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***
> > >
> > >
> > >_________________________________________________________________
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