****** Forwarded Message Follows *******
>To: NARRATIVE-HEALTH- [log in to unmask]
>From: [log in to unmask]
>Date: Mon, 5 Nov 2001 11:27:47 GMT
>>>Tom
>>>Thank you for the response which has made me sit down and think.
>>>"The meaning of the pain" in my context is what the person thinks is the
>>>mechanism causing the pain. Low back pain is the commonest presentation,
so
>examples here would be:
>>>I'm riddled with arthritis
>>>My bones are crumbling
>>>My vertebrae are out of alignment
>>>My discs are shot to pieces
>>>Fragments are pressing on the nerve
>>>Bone is grinding on bone
>These misconceptions are clearly vitally important but can be difficult to
elicit.
>If one asks too early on "What do you think is causing this?" the response
is
>along the lines of "Well you're the doctor".>>
>
>>>Underlying this sort of mechanical perception there are often other concepts
>of why the situation arose in the first place:
>>>It's that surgeon's fault
>>>I had to work very hard all those years bringing up the children
>>>My husband never helped in the house
>>>The boss never used to believe how much pain I was in
>>>
>>>The expectations for the future are often very bleak:
>>>I'll obviously end up in a wheelchair
>>>I'll be completely crippled like Aunt Mary
>>>I'm just getting worse and worse
>>>
>>I'd be interested in ideas about how to approach this in a way that could
help
>the person construct a more "enabling" story (in those situations where there
>is no relevant physical pathology and no appropriate medical treatment). Quite
>often the misunderstandings over physical pathology have been initiated by
doctors
>giving out unhelpful information, eg "your Xray shows degeneration" instead
>of "your Xray is normal for your age"."Degeneration" is often reinterpreted
>by the person as "disintegration" or "deterioration".
>
>In some cases simple explanation helps, with a model of the spine, but more
>often a whole lifestyle has been built up around the misconceptions and it
is
>unrealistic to expect that to be reconstructed on the basis of a few bits of
>edifying facts from the doctor.
>>Judith
>
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