Brain Training

On rural prac, I conducted community classes for patients with chronic pain. The group consisted of 4 patients all of whom had some sort of spinal condition and had experienced chronic pain for 2 years or longer. To be eligible to attend this group participants were screened for suitability. 3 of the patients saw the group as a way to change their lifestyle and reduce their pain, however one particular group member saw the group negatively becuase he felt that surgery and medications had not helped him in the passed so how could physio? After all all we do is "massage" according to this lovely patient.

The group commenced, totalling a 3 week full time program, with sessions from pain specialists, psychologists, OTs, dieticians and physios. I conducted the physio part of the program taking the patients for a very light cardiovascular work out as well as light stretching and mobility exercises. During the class the patient would never do anything properly, and when asked to try and change his technique the patient would become upset and tell you that this would put him in a wheelchair and that he wasnt going to do any of it.

3 weeks passed and the post re assessment took place. Other participants in the group genuinely expressed a enhanced QOL and reduction in pain, putting into practice what they had learnt over the passed 3 weeks. This patient however remain skeptical and still scored his pain highly and gave us feedback that the group was a waste of time.

This patient I thought needs "brain training," it was his mind set that was holding him back from getting better, rather then his impairment. This highlighted to me the need to identify such patients early during physiotherapy programs, and provide them with more education based management rather then hands on management as a change in mind set was required for them to benefit from physiotherapy. By encoutering this patient it highlighted the need to identify such patients during your subjective examination and then subsequently tailor your treatment in such a way as to make them understand that mindset plays a huge part in your perception of pain and our injury.