Whilst working in the gerontology field for this placement the notion of pain has presented itself quite differently. Normally within the other areas of physio, pain is one of our patients’ main complaints and is a limiting factor to their range, strength and overall function. My patients seen this week have experienced pain unlike anything imaginable; many have been injured at war, given birth rurally without any help, have audible crepitus and degenerative joints. Pain to them is a normal daily occurrence and not a problem that will be mentioned upon subjective and objective questioning.
When observing patients normal movement and during exercises my supervisor questioned me on the underlying reason behind her ideology of conservative treatment for this population group. To me, the antalgic movement patterns could be pinned to their reduced muscle strength and poor balance or some patient’s history of CVAs; and a prescription of five repetitions of an exercise once a day or three times a week even, would not be beneficial for a strengthening program. The supervisor then brought to my attention that many of these patients live with pain during all their day-to-day activities and did not feel that it was a problem worth mentioning. She gave me an example of where she too had to “read between the lines” when a patient who was once able to walk to 100m to the shop with a 4WW had recently bought a gopher to take her instead. It wasn’t due to poor exercise tolerance, a fear of falling or poor balance, but instead my supervisor suspected that it was an increase in pain that led her to buy the gopher. At no time had pain been mentioned to her as a problem, or the reason behind the gopher. Similarly with the prescription of exercises, for this population group, pain would not be something that would hinder them from performing their exercises. This could potentially heighten their underlying problem and make them worse; unlikely to listen to their bodies signals a very conservative approach is necessary.
With this in mind, I have found that although my patient’s may not complain of pain, whilst doing activities during individual treatment and during their HEP, I need to be aware of not overdoing things. In some cases, if I allow them to continue during the treatment this may limit their ability to carry on the rest of their day safely and may lead to further problems. Subtle changes to the performance of exercises during my treatment may indicate an increase in baseline pain levels or some discomfort that will not be mentioned by my patient. It is my responsibility to decide when the patient has done enough and not take their appearance on face-value.
1 comment:
I agree with you, sometimes as students we expect pain to be the foremost symptom of our patients but in many cases this is not as obvious as a patient saying "ow"! This not only applied to elderly patients, in my musculoskeletal placement I recently treated a young woman with chronic neck pain. She explained to me following my Subjective that she was so used to 'blocking the pain out' that it took her a while to remember or 'feel' her pain when i questioned her about it. I think this 'blocking out' or going-on-with-life attitude is similar to that experienced in your elderly patients. I agree we must look for non-verbal signs of pain in all our patients and furthermore sometimes express to them that pain is not something you just have to live with, that in most cases it CAN be treated and reduced.
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