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Re: Fibromyalgia
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Re: Fibromyalgia - January 1, 2005 3:52:00 PM
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Jon Newman
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Flo,
You and others did address some of the same aspects that Hadler addresses in this editorial, especially that part about medicalization of widespread pain. However, Hadler, et.al made some additional points that seemed to be missing from other posts.
In particular:
"It is not the pain that drove them to seek medical care; it is the suffering consequent to the uncertainties the pain precipitates in their mind... It is suffering that demands recognition and care (emphasis mine). When people with persistent widespread pain seek care, it is because they have exhausted their wherewithal to cope and are casting about for attention to their suffering. Isn’t “cognitive behavior therapy” a sophisticated attempt to educate these adults in self-awareness and in finding and choosing accessible alternatives in life? Can’t medicine learn to provide such as part of a treatment act?
I think the last question raised is important, don't you?
jon
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Re: Fibromyalgia - January 2, 2005 6:05:00 AM
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Dr.Wagner
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One of the things that some of you just do not understand is that many of these patients are manipulators. They will manipulate you to get exactly what they want based upon the fact that someone has given them a diagnosis that is objectively difficult to measure and has lifelong poor prognosis. For many people "fibromyalgia" has given them an excuse and for many others "fibromyalgia" has given them something to treat or justify virtual lifelong treatment.
You see, I have what MANY with fibromyalgia want...they manipulate me to get their meds, to get their "day off slip", their parking permits, their excuse to not do something. They want people to feel sorry for them. They want an excuse to NOT do something, they want a reason to take their breakthrough narcotics. How many times have I heard "oh my gosh my back hurts so bad...oh I can't move my shoulder I have fibromyalgia...I am allergic to ibuprofen, ultram, steroids, darvocet etc...I can only take vicodin or demerol" They will have the utmost sincerity in their eyes, but you look at the number of their previous visits and realize they are just lying...absolutely lying to your face.
Sorry but I firmly believe that over 50% of those with fibromyalgia are full of sh@t...and the last thing they need is anyone to feel sorry for them. Fibromyalgia is a psychiatric disease of Americans with too much time on their hands.
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Re: Fibromyalgia - January 2, 2005 6:33:00 AM
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Jon Newman
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I'm not sure who here is feeling sorry for these people. My call is to care about the very problems you raise. To care that this is not the answer to their problems. To care enough to not medicalize their aches and pains in the absence of obvious pathology, fibromyalgia or not. The problem I see is that some don't understand that they are in a position to offer more than pain meds, day off slips or exercises. In short, I'm calling for compassion versus sympathy.
jon
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Re: Fibromyalgia - January 2, 2005 1:31:00 PM
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FLOrthoPT
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is it our job to offer compassion or our job to refer them to someone specializing in the mental health field? I am full of compassion, and full of other stuff too ;) , but I do not think it is my job to always be the patients friend, the only things I will ALWAYS be, is that I will be an advocate, I will be a professional, and I will be honest. Sure it stinks being injured and in pain, I have been there, but I do not feel that I need to validate someone's pain always, I do feel that psychologists specializing in dealing with chronic pain are needed more and more, and they are better suited to handle these patients. Good for you for taking the time to hold a patients hand, etc, I am not knocking you, just not my style...nor do I feel that it is my RESPONSIBILITY as a healthcare professional specializing in movement science and rehabilitation of movement dysfunction to be their mental health professional as well. Maybe we should all have more compassion, or maybe we should push to have more chronic patients referred to pain specialists who have psych on staff.
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Re: Fibromyalgia - January 3, 2005 3:59:00 AM
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Jon Newman
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As a professional specializing in movement science and rehabilitation of movement dysfunction I know you understand that what drives movement directly begins centrally. And at least one thing that influences that motivator is exteroception (as does interoception) and the processing of such information. I'm not advocating that we act as mental health professionals and try to diagnose DSM labels and treat those labels but simply to acknowledge the above.
A quick look at the Guide for Professional Conduct reveals the following:
Principle 1
1.1 Attitudes of physical therapists
B. Physical therapists are to be guided at all times by concern for the physical, psychological, and socioeconomic welfare of those individuals entrusted to their care.
Although, as you allude to, you can fall back on principle 3.1 B
If the diagnostic process reveals findings that are outside the scope of the physical therapist's knowledge, experience, or expertise, the physical therapist shall so inform the patient/client and refer to an appropriate practioner.
To be clear, the definition of compassion that I am using is (Webster's 3rd): deep feeling for and understanding of misery or suffering and the concomitant desire to promote its alleviation
I don't see in that definition that "validation of pain" or "hand holding" are necessary but each person is unique in their needs and being able to recognize what needs to be done is difficult, at least for me.
Dr. Wagner's plight is unenviable. I wrote of a similar problem in the thread "Great Expectations" only the details are different. My question from that thread still remains, how do we change these expectations? I think when I can answer that I'll have done much to alleviate suffering (both mine and the patient's).
jon
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Re: Fibromyalgia - January 3, 2005 5:45:00 AM
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Diane
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Well said Jon.
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Re: Fibromyalgia - January 3, 2005 9:16:00 AM
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Dr.Wagner
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Perhaps it is that I see some real dirt bags out there, and with anything, they can overshadow those with true pathology. That being said...I have had the most sincere people lie to my face primarily because I have something they want.
It is an eye opener. As a PT I wanted to help, as a physician in the emergency department...I see so many that do not want help, but rather an excuse and someone to recognize their "problems".
It is sad. I am glad that there are some very well motivated PT's out there that are sincere and want to help those in any way they can.
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Re: Fibromyalgia - January 4, 2005 4:32:00 PM
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Jon Newman
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Dr. Wagner I have lots of questions (a bit off topic),
I'm curious about your predicament. What are the pressures to prescribe narcotics past patient demand? What would happen if you did not prescribe narcotics, besides having an unsatisfied customer? Would your workplace back your clinical decision not to prescribe? Would they back you if you didn't give them a parking permit or a "day off" slip. I'm familiar with the patient's bill of rights as it pertains to pain, do you feel that is an issue?
You're right, some patients lie, many leave out details, exagerate, etc. If they're good enough at this and you take them on good faith, does that make you a bad MD? On the other hand, if you "know" you are being lied to, etc, and feel forced to do what you do not want to, well that would be awful.
jon
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Re: Fibromyalgia - January 4, 2005 7:38:00 PM
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Dr.Wagner
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Well remember I work in an Emergency Department...
I prescribe what ever I want, but usually chronic pain patients REQUEST certain medications and may lie about allergic reactions to common meds. Oh dear lord it is blatant. And because I am in an ED and we move faster than you can imagine, we may just give in. I try not to, but patients demand alot of things ( I remember a patient demanding percocet to the point she flipped out and made a monstrous scene). You do what you can, but there are so many "pain addicts" that they stress the system. Then there are the lawyers who may bring a lawsuit based upon "pain and suffering"...or the patients that write letters because we "don't believe their illness"...there is a terrible burden placed upon those who prescribe.
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Dr. Wagner DO
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Re: Fibromyalgia - January 5, 2005 2:26:00 AM
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Jon Newman
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So if you were King of the world, what would you do to change things?
jon
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Re: Fibromyalgia - January 5, 2005 8:48:00 AM
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Dr.Wagner
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I would drive a bigger car and my son would always be happy.
People are often times in control of their own path in life, in other times they must be accepting of the lot they have drawn. I am not in control of their pathology nor of their psyche...they must leave the cult of pain.
And of course I would make lawyers get real jobs.
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Re: Fibromyalgia - January 6, 2005 1:47:00 AM
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Jon Newman
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Thanks for the conversation.
And may your son never say, "Dad, I want to be a trial lawyer" or you'll really have a dilemma.
jon
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Re: Fibromyalgia - January 6, 2005 6:30:00 AM
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Dr.Wagner
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From: Indianapolis
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Thanks...
Have a good one.
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