Know Pain or No Gain — Patient Education is Key
Over the past decade we have seen an explosion of research on how to become more effective in dealing with patients who are in pain. Global statistics consistently demonstrate 25 percent of the world’s population deal with chronic pain. Looking at current research, one of the overriding treatment strategies is patient education.
Patient education has long been a cornerstone for the rehab profession. Once again, we have the knowledge and skills to improve outcomes in this challenging population. Providing pain education early on in the rehab process can put a patient at ease, improve outcomes, and prevent a patient with acute pain from evolving into someone with chronic pain.
The primary goal is to help people to understand their situation and become less frightened of their pain. Pain is normal and stands as our body’s protective and alarm system. Pain can warn you when you have been damaged, when you are approaching damage, and it can even warn you if you are in a situation similar to a past experience in which you experienced damage. Pain is a very complex experience.
It is important for patients to understand that all pain experiences are normal responses to what their brain thinks is a threat. The amount of pain they experience does not necessarily relate to the amount of tissue damage. Often this “pain experience” is the limiting factor in helping people understand their chronic pain. The construction of the pain experience of the brain relies on many cues including the social, emotion and spiritual circumstances surrounding the initial insult. For example, if an injury originally limited the ability of your patient to perform job tasks, painful experiences might be linked to the workplace. As another example, phantom limb pain can serve as a reminder of the virtual body in the brain.
Clinicians should also help patients understand their radiology reports. These reports often show degenerative changes in the body, which is often concerning to the patient. Degeneration is a normal part of aging of all tissues, and many patients have joints or discs that look terrible on X-ray but have no symptoms to correlate with this damage. By example, as we age, we get wrinkles that appear on the outside. Patients need to understand that many of the radiology reports demonstrate wrinkles that occur on the inside. The results of these radiology reports do not necessarily point to pathology and pain and should not lead our patients down a path of inactivity but to their nearest rehab professional for expert guidance on appropriate exercise and activity modification.
A pain management program of evidence-based practice provides therapists with many choices on modalities, manual therapy techniques and exercise. Taking the additional time to educate our patients about their pain is a great complement to our services and will do nothing but improve outcomes.
Rehab director and physical therapist Steve Finn has been a practicing therapist since 1992. He is a certified specialist in orthopedic physical therapy, is trained in McKenzie techniques for spine rehabilitation, dry needling, ASTYM, and is the lead therapist for the chronic pain program at his hospital.