While on placement in the country I received a referral for an elderly patient who had multiple problems associated with Polymyalgia rheumatica, which had been present for two years. This patient had multiple sites of pain- the shoulders, neck, temporal area (due to associated giant cell arteritis), low back pain radiating into the left leg and also bilateral hip pain. She mobilises with the aid of a four wheeled walker and was previously completing a home exercise program consisting of walking and LL strengthening exercises. However she ceased these following a fall five weeks previously.
Initially I was unsure of where to start with my assessment, however she stated the wish for her lumbar pain to be treated. I initially felt a bit overwhelmed with all her areas of pain, however as she wished I focused solely on her back during the sessions, with advice to recommence the walking program. After the initial session where I performed PPIVMs (rotations) and piriformis releases and soft tissue massage, she reported a reduction in her pain in the lumbar area. Over a series of treatment this continued.
From this patient I have realised that although a patient may have multiple problems and areas of pain, if you can start by easing just one area, this provides great relief to the patient. Also I have realised patients often don’t expect you to treat everything initially, but gradually work through the problems. In the future I won’t feel pressured to work on multiple areas of pain (unless they are related) and understand that to someone with chronic pain a small reduction in pain (or in one area) may greatly improve their quality of life.
3 comments:
I think its fantastic you were able to reduce the patients pain. Something that may be important in the future is a management component to your intervention. This will allow the patient to feel more empowered over her pain and feel that independently she is able to reduce her pain.
Good approach. When patients present with multiple problems or pain areas, i ALWAYS ask them what their primary concern or problem is and explain why we may start there and not address all areas on day 1. I often explain to them that the areas are not "directly" related and its important to do a good assessment of one region rather then partial assessments of many regions. In addition, people with multiple complaints of require an emphasis on self management / active approach as suggested by Lennon. Doing this, you can often address multiple components together.
I had a palcement where i was seeing lots of chronic pain patients and what I learnt was that yes there were multiple sights of pain, but by asking the patient what their main concern or functional limitation was it allowed a direct approach on a source of the patients symptoms, and once you started to see improvement in the area and the patient began to be able to manage with that certain pain much better then you could perhaps move onto the next problem area.
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