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Old 14-10-2004, 03:23 AM   #1
nari
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Default explain away pain - atypical case!!

Will try to write up on someone I saw yesterday by tonight.

It fits the book Explain Pain extraordinarily!!


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Old 14-10-2004, 07:41 AM   #2
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Nari,

We can't wait so long! :shock: :lol:
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Old 14-10-2004, 10:55 AM   #3
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A 58 yo woman, with anxious demeanour and tense body language, sits down; I take her history and know she is keeping a great deal from me.
She was kicked in the (L) scapula/post shoulder region by a well built autistic adolescent, which catapulted her forward against the solid surface of a bus. She is a carer for intellectually disabled children.
The psychologist informed us that she has a horrific past history of abuse.

She has:
- had complete (L) sided pain and loss of function for 14 months; from the trigeminal nerve distribution on the left side of her face to the fascia on the sole of her left foot.
- she sleeps poorly, has altered gait pattern, asymmetrical, and awkward.
- she is medicated, but minimally. on analgesics. no opioids.
- her left arm is maintained mostly in a position of adduction, elbow flexion and IR; the typical protective pattern. There is minimal function but she can use it for tasks well under 90 deg flexion and 30 deg abd.
-her pain drives her completely; she is aware of it constantly if she is resting or moving or talking.
-it eases when she is with her kids, and when she meditates.
-it returns as soon as she stops those 2 things.

She refused an physical assessment, so I asked her to do some active movements, which she did, and ROM was reasonable but with pain. her left arm did not move.
So my only option was to educate her on the nature of persistent pain, the virtual body, representations and sensitisation.
She listened, and her eyes grew wider and wider, as I went through the paces, with her agreeing, nodding, eyes nearly falling out of her head.
Her entire body language changed, she relaxed, leaned casually on her LEFT arm, and kept agreeing. I showed her that she was using her left arm normally - and she said 'I know!'.
She unfolded when I told her she had not use for this pain and to go for a walk, as she used to. I cued her to stop limping and swing her arms.
She went down the corridor, at a pace, squawking: " I haven't any pain!
It's gone!" She rushed back and said: " I can't believe it -it has gone after 14 months". I was about to ask her did she understand why, and had my breath taken away with a massive bear hug.

I warned her it would return, and did she know what to do??
"I do.." and she waltzes off, with a Cheshire cat grin.

This has happened before, but this was fast; her pain just evaporated.

I think I understand Barrett better now give then permission to move as they want? Except I did it through talking about neurophysiology.

Comments, all!?


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Old 14-10-2004, 04:06 PM   #4
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Nari, brilliant intervention. Just brilliant. You preserved and respected her boundaries, maybe helped her grow some healthy ones. You may have pulled her back from the brink of being labelled a conversion disorder. You saw something in her that very much needed to be seen and spoken to, that others in their "need" to find the "source of the problem" might have overlooked or disregarded, or to whom this aspect of her would have remained invisible. Once that part of her felt addressed and accepted, she morphed herself.
I loved your story and I hope you'll post more like this. I want to become as theraputic as you, as skilled as you are in applying hands-off treatment.
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Old 15-10-2004, 05:21 AM   #5
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Diane
Thanks for your kindly words.

The weird thing about this event was the spontaneity of it - I couldn't think of what to do next after she requested no assessment, and education was all there was left. At least I figured she was safe with nontactile, verbal communication with no questions on my part.

As my story unfolded, so did hers, plus some baggage, though far from all of it. I think all I did was allow her to understand that she did not need this pain -words I put away somewhere from David's course - and that really got her out of the ditch.

She will fall in again; her baggage is large- but maybe with more insight into why she falls.


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Old 15-10-2004, 06:54 AM   #6
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Nari,
Quote:
She will fall in again; her baggage is large- but maybe with more insight into why she falls.
Or maybe she will fall again but get herself out right away, as soon as she hears your words echoing in her head..
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Old 15-10-2004, 08:17 AM   #7
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Well Nari,

I'm very jealous of your communication skill (but I'm learning with your help). It is brilliant for sure. A talking body as we say and it reflects all the internal misery of the human being.

The major problem is to find the right words to move it!
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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 15-10-2004, 09:12 AM   #8
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Bernard

I don't know what the right words are - they are not quantified. Someone else asked me what did I say to her; I can't really remember other than a few phrases...

And this is it.. it seems that a few phrases will turn a key somewhere.
One of them is validating their pain.

But these phrases won't be the same from one patient to another.
what is said to a 17 yo female is quite different from a 40 yo, or a 60 yo male, etc.

Can't explain it. What has helped in the past to 'switch' onto a patient has been NLP - neurolinguistic programming, the essence of which is working out the next moves in a dialogue from body language and verbal expression from another person, eg patient.


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Old 15-10-2004, 09:31 AM   #9
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Nari, Bernard,
Quote:
What has helped in the past to 'switch' onto a patient has been NLP - neurolinguistic programming, the essence of which is working out the next moves in a dialogue from body language and verbal expression from another person, eg patient.
I believe that this is also referred to as "tracking", which means closely observing a person's responses to whatever you the practitioner are doing, so that you can respond appropriately to their unconscious cues. I can do this most easily kinesthetically, it's definitely my default pattern as a practitioner. But we've established that for some patients, physical contact is too much for them. So I need to
1. either become more versatile, expand my skill base of tracking into visual/auditory better, or...
2. be content with being r-e-a-l-l-y good at kinesthetic tracking and leave the hands-off stuff to Nari!

I've had a bit of luck being hands-off for some people, but not much.. I'm known for my hands-on skill, and I get so positively reinforced for it that sometimes I don't spot the ones that need something different from me.

There's such a narrow window of opportunity, that first visit, to make the 'click' with someone. (Like the window of opportunity for newly hatched chicks, ducklings etc. to "bond" with the first moving object they see.. usually their mom but not always..)

If this hasn't happened for sure, and you treat them hands-on, it's too late and you've ruined your chances of getting that elusive, and for me still hard to spot, still invisible part of them to listen to you, to click with you. It has turned off and the pain has turned itself on again, and the look at you like they bested you in chess. Another therapist bites the dust in their world. Pain, 1; therapist, 0

Do you have actual NLP training Nari? If so you are a mile ahead of the rst of us. One more thing to add to undergrad school, to turn out good physiotherapists!

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Old 15-10-2004, 10:17 AM   #10
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Yes, I went to a hospital-funded three day course here in Canberra.
Very interesting - though I was sceptical at first,as I am with everything I go to!!


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Old 15-10-2004, 05:16 PM   #11
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Wow! I would LOVE to do an NLP course. I would frame it as simply sensitivity training. Obviously some of it stuck! Must be just the right combination in your case study here, you had training to help you slow down your own perception to the speed of her "stuck" bit, and the ability to tune into that aspect and talk directly to it. I am sold. I will now be on the lookout for NLP courses here in the city. They can't be any more expensive than any other out of the box cont ed I've taken for fun.. I spent two years studying fine art!
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Old 15-10-2004, 09:33 PM   #12
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hi Nari!
nice story!you seems to have exelent communiction skills!
The negative emotional right brain side seems to been dominant,and her left side might have been in pain due to increased muscular tension!
These patients do not have any strengt at all in the left side due to the dominat fireing of the right brain hemisphere(just a teory)
RIN :wink: :wink: :wink:
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Old 16-10-2004, 02:23 AM   #13
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Diane, I don't know if NLP is as 'trendy' as it was in the 80s, but some of its concepts remain in interviewing techniques - eg mirroring the person you are with in body language.
I think you would really enjoy a course in NLP.


Rolf -

You may be right, I am sure her (R) hemisphere was loaded with negative emotions, which may well have affected motor performance of her left side due to pain..but once she 'recorded' some feedback which validated and interpreted her pain experience, it still amazes me the speed she returned to normal body language and movement...


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Old 24-11-2004, 08:35 AM   #14
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Hello Nari and Somasimplers,

Here is another similar case.
http://p214.ezboard.com/fphysiobasec...opicID=3.topic
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Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 24-11-2004, 09:02 AM   #15
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Bernard,

I would like to comment on this case, although others have certainly made suggestions on the right track - but I still cannot get registered, and have not bothered to try again.

With a bit more time, I will try to get registered!!


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Old 24-11-2004, 09:08 AM   #16
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Nari,

I experience the same problem with the login on PhysioBase.
As I said earlier, the first registering discarded the password you filled in!
Now you have an account but a password that you do not know!

Enter here your unsername =>
http://www.ezboard.com/help/form_forgotpassword.html
and you'll get the right password filled in by PhysioBase.
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Simplicity is the ultimate sophistication. L VINCI
We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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