three articles in PAIN journal

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nari -> three articles in PAIN journal (January 5, 2005 7:35:00 PM)
I would like to advocate the latest edition of the PAIN journal as good reading: particularly: PAIN Vol 113, issue 1-2, Jan2005, pp 238-239, 240, 240-242. These letters to the Ed describe the problem of dualism-thinking, and the need for a new approach to measure the psychosocial impact of CRPS1. lots of interesting references... Nari

SJBird55 -> Re: three articles in PAIN journal (January 11, 2005 12:41:00 AM)
I would like to ask a really, really dumb question, but I would be interested in some ideas. A few weeks ago, I had a young lady who had been in a motor vehicle accident begin physical therapy. The low back pain she was having was from that incident and that was about 3-4 months ago. Sometimes I wish I had more tools to utilize with patients to understand better, but on the Oswestry she had an 82% disability. I don't have the fear avoidance tool, but she did have a lot of fear. She also had a lot of depression. Objectively, I found nothing wrong with her. I did address her fear with her - I spent a lot of time just talking to her and hopefully increasing her confidence that all the things I worry about when it comes to back pain (neurological involvement... fractures...) are all negative. She talked about her fears... she talked about her depression. I communicated the psychosocial factors that were significant variables that needed to be addressed in order for this lady to have good outcomes with her referring physician via a fax (they normal communication style here). Well, the lady saw the physician... the physician never responded to me... and the lady never came back. I know psychology doesn't fall under our scope of practice, but how do others handle situations like the one I was in?

Diane -> Re: three articles in PAIN journal (January 11, 2005 2:15:00 PM)
Hopefully the MD sent her to someone who could help her with her depression. If she had nothing for you objectively, then maybe she's in more appropriate hands, for the psych stuff.. still it would be nice for you to know what happened to your patient. Diane

nari -> Re: three articles in PAIN journal (January 11, 2005 10:12:00 PM)
This is a tricky one, and we would hope the doctor recognised that you noted her psychsocial issues were the ones to be addressed, and not the manifestation of them. I don't use the word somatisation - an outdated word, as it suggests the pain she feels is not real; which is disastrous and incorrect. If her issues were appropriately addressed, then her back pain would probably resolve, but if it didn't, then one would hope she would come back to you. That's the best I would hope for, anyway. Sometime in the future all PTs should be able to address these issues of fear and anxiety; but at present, with separate professions for various bits of the brain/body - it will not be easy. Talking with her was a good start, and sometimes it is enough. Sometimes it isn't. See if you can get copies of the Quebec form and also TAMPA. They are more helpful because they don't harp on the word 'pain'.. Nari

nari -> Re: three articles in PAIN journal (January 11, 2005 10:44:00 PM)
This is a tricky one, and we would hope the doctor recognised that you noted her psychsocial issues were the ones to be addressed, and not the manifestation of them. I don't use the word somatisation - an outdated word, as it suggests the pain she feels is not real; which is disastrous and incorrect. If her issues were appropriately addressed, then her back pain would probably resolve, but if it didn't, then one would hope she would come back to you. That's the best I would hope for, anyway. Sometime in the future all PTs should be able to address these issues of fear and anxiety; but at present, with separate professions for various bits of the brain/body - it will not be easy. Talking with her was a good start, and sometimes it is enough. Sometimes it isn't. See if you can get copies of the Quebec form and also TAMPA. They are more helpful because they don't harp on the word 'pain'.. Nari

nari -> Re: three articles in PAIN journal (January 11, 2005 10:53:00 PM)
This is a tricky one, and we would hope the doctor recognised that you noted her psychsocial issues were the ones to be addressed, and not the manifestation of them. I don't use the word somatisation - an outdated word, as it suggests the pain she feels is not real; which is disastrous and incorrect. If her issues were appropriately addressed, then her back pain would probably resolve, but if it didn't, then one would hope she would come back to you. That's the best I would hope for, anyway. Sometime in the future all PTs should be able to address these issues of fear and anxiety; but at present, with separate professions for various bits of the brain/body - it will not be easy. Talking with her was a good start, and sometimes it is enough. Sometimes it isn't. See if you can get copies of the Quebec form and also TAMPA. They are more helpful because they don't harp on the word 'pain'.. Nari

nari -> Re: three articles in PAIN journal (January 12, 2005 10:14:00 AM)
Sorry about the above - the computer froze twice and it did not acknowledge in the usual way that the response had been posted.... Nari

Randy Dixon -> Re: three articles in PAIN journal (January 12, 2005 11:00:00 AM)
I was in the bookstore the other day and looked through a book by Sarno about curing back pain. He is a doctor who went from being mechanically oriented to his current stance which is that most back pain is all psychologically caused. His treatment plan seems to consist of telling the patient it is just psychological, not to be afraid to do their normal activities, not to move, lift or exercise in any specific way, and to basically just ignore the belief that their back hurts and realize it is all caused in their heads, a result of stress. The physical cause of the pain he calls tension myotosis, a lack of oxygen in the muscles caused by guarding and other behaviors. This is from a pop medicine book, but given what we know about things like fear avoidance beliefs and the predictors for chronicity in back pain, it might be worth considering. That is that maybe you did all you could for her and maybe even that it was enough.

nari -> Re: three articles in PAIN journal (January 12, 2005 12:03:00 PM)
Sarno is possibly in the right direction but sounds as if he has gone overboard with his new boat. Stress comes in all forms: mechanical, physiological and cognitive..but the mechanical 'spot' in the back or arm or knee is possibly the 'weakness' in the system that the brain hones in on when it perceives danger. Nari

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