My issue today concerns a patient that I have seen three times. She presented to my supervisor a number of weeks before I got to Tom Price with severe pain in her thoracic spine and shoulders, with pain radiating down into her arms. The first time I treated her, she spoke about how she was consulting reflexology books and how she was getting the oldest of her six children to do "pressure point" massages on her every day to relieve her pain. Additionally, she was constantly stretching her neck and shoulders in every direction in order to relieve her symptoms. Treatment involved some trigger point massage and education regarding posture, in addition to exercises to promote scapula stability. All of these were indicated by objective examination. Additionally I asked her to stop having her children trigger point her (even though it brought temporary relief) because aggressive soft tissue techniques such as that every day may actually be aggravating her condition. I also asked her to avoid the continuous stretching she was doing. My reasoning was the same. I wanted to see what the situation would be if her muscles were given a break for a week. This was always going to be difficult. The patient does have six young children and is always on the go so the concept of rest is understandably foreign to her at this point.
Nevertheless, and to her credit, the patient tried to stick to what we'd spoken about.
One week later, the patient appeared in similar condition, complaining that a host of pain medications had not made a difference either. On examination she had normal ROM, and the muscles around her upper back and shoulders were relaxed. Palpation was still very tender and she complained of pain no matter where I placed my hands. My issue is that despite the raft of tests I have done I have no idea what is going on. My supervisor is not sure either, and says that the patient is paying too much attention to her pain.
The lack of objective information is confusing, and I'm certainly convinced that there is a psychological and behavioural component to her pain. That said, I'm not about to label her an "attention seeker". Regardless, the next step is one that I'm not sure about. Ideas?
M
Subscribe to:
Post Comments (Atom)
1 comment:
Hi Martin,
Sounds like a really interesting case! I think I had a similar patient while I was on my musculoskeletal outpatients prac. It was a lady with back pain who had no real objective problems, though reported her pain to be very bad. I tried everything while I was there, from STM to mobilisationgs, stretches, HEP, core strengthening and E stim to name a few. However she never reported getting any better. When she came in though, she would always say "i think i need a really long massage"... and towards the end I wondered if she was coming in to get a "free" massage, rather than the other treatment! Although in cases like this, all I could do was try a range of treatments. When nothing worked (she had been coming for about 8x 1 1/2 hr treatments) I had to discuss with her the other options available. These were referral to another physio, revisiting the doctor for advice, trying another health professional, or trying to change parts of her lifestyle so she had less stress on her. She decided to take a few weeks off physio and try to have a few moments each day to relax & unwind.. I'm not sure if it worked or where she is now, but my view on the situation is that if nothing works then refer them to someone else IF YOU CAN. Its hard in rural areas but there is no point hitting your head on a wall and getting no where. What do you think Martin? Anyways, hope all is well. See you soon. Caris
Post a Comment