I'm not convinced that it is helpful to categorise patients into those
with a condition that may be linked with psychological disorders, and
those without. Surely it is better to assess the individual rather than
the condition?
In my experience, patients with chronic pain have varying degrees of
psychological distress (some exacerbated by being told that their pain
is "psychological".) Some cope fine, some find it a real struggle. We
have to recognise that purely physical therapy is not a cure-all, and
need access to methods to enhance the patient's coping strategies when
we identify problems.
If treatment approaches have failed, it may be necessary to admit this
and change tack. From trying to cure their symptoms (I agree, this is a
very difficult task) it may be more profitable to start enabling them to
manage their symptoms by helping them to set goals, pace activities etc
and gradually lose the fear of movement. (This has sometimes been a
humbling experience as I watch my patients succeed where my own efforts
at treatment have previously failed.)
Our pain management programme has had good results with fibromyalgia
patients - they'll never be free of pain and fatigue, but that was not
the aim of the intervention. What they do gain is the confidence to
cope, sit through the whole of Titanic, get rid of their corsets, walk
just as slowly but smiling and able to hold a conversation - different
goals for each person. These goals are similar to several other people
in the group without fibromyalgia - for our group, the diagnosis isn't
as important as the person's willingness to change.
I am lucky to work with an excellent clinical psychologist who has
taught me a tremendous amount, and an equally excellent OT who is busy
educating me on the finer points of pacing. They can't work without my
input, and I can't do without them. Pain problems are multi-faceted, and
therefore need multidiscipinary intervention.
Regards,
Carol David
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