We all have the patients that are obsessive over their diagnostic imaging findings. They are fearful for you to even evaluate them without reading their MRI reports. Some of the most distressing words we hear as clinicians can be, "have you seen my imaging reports?" Immediately, the patient is at risk for becoming a slow responder due to the presence of perceived threats from the reports. Recently, I had a patient who had an MRI that revealed some disc herniation in her lumbar spine. I tried to educate both the patient's family and another involved health care practitioner on how disc abnormalities can be normal in teenagers and twenty-year-olds as many are asymptomatic with those same problems. No matter what I said, there was a level of fear in that patient's family (likely heightened by the confirmation from the other practitioner) that could not be shaken. Recently, a study came out showing just how common disc bulges can be. Between 70-78% of asymptomatic individuals in their twenties have a disc bulge in their cervical spine. This further increases the evidence of how it is a normal aging process. The fear instilled by imaging can be difficult to treat. It is by far my weakest area as a physical therapist. I used to think it would apply to a small population, but it appears to become ever more important with the progression of pain science. I currently am reading Therapeutic Neuroscience Education and have read Explain Pain in order to develop my methods of educating patients on pain science. What other sorts of resources or methods do you use in this area?
3/18/2015 01:04:47 am
3/18/2015 01:58:32 am
JAMES---any chance you are now 'experienced' enough to be a CI?
3/18/2015 02:35:28 am
I find using logical arguments to make people realize pain is not a threat (or imaging) works well. For example, in that case, like many, pain is intermittent, it may take a bit more questioning for them to realize that. If they end up saying their pain is worse in the morning, but better as the day goes on, you can ask them, "Do you think your MRI looks worse in the morning, and then improves as the day goes on?" Replace that with movements, positions of ease and irritation and most people realize the MRI is just what their spine looks like when they're lying in a tube.
3/21/2015 09:28:38 pm
Starting up my stopthoughtviruses.com again with infographics for the public and clinicians. http://www.stopthoughtviruses.com/2015/03/low-back-pain-and-imaging.html
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