In the world of chronic illness and pain, we discover significant difficulties in treating the ailments, due to such complex entities. Sometimes the symptoms can be so complex, the practitioner has difficulty determining key points in the diagnosis. It is unclear what is the cause and what are the residual effects. Sometimes, we can be treating the correct diagnosis and problem, but the other complicating factors are too strong to allow you to see the benefits or improvements that would be expected. This leads to confusion and complications to the patient’s overall prognosis and success.
I have found that with chronic illness there are some interesting characteristics that are commonly shared amongst patients:
- They all tend to want to get better.
- They all would like to have answers.
- They are all usually tired of the false promises that they’re going to get better and start to lose all faith in the system.
- They feel that they are helpless and will never feel normal.
- They usually have a list of exams and tests that have not helped with clarity of the diagnosis, but have in some ways helped cloud up the potential of discovery due to too much “static” interference of excessive information.
I started realizing there is a primary problem that seems to be consistent in chronic pain—the inability to recognize normal. This maybe the most significant reason we do not see that a patient heals. A simple example of this is when I was speaking to a patient about his improvements in therapy. He has been fighting chronic pain and illness for the past 12 years and for 2 weeks was pain-free while in therapy. We were excited and felt we figured out the root cause of his problem. But then the pain returned to the old state. I questioned him significantly about potential causes of the pain including stress and activity. He noticed there was no significant change in his day-to-day life. As I was treating him, he did say, “When my neck was feeling better it felt very weak, I think we need to strengthen my neck.”
It was at that moment I realized that the patient could not recognize what normal felt like. He misinterpreted the feeling as being weak rather than normal. This is because for the last 12 years his normal has been significant tightness with his pain. Now, normalcy felt like weakness. By him labeling his sensation wrong, the body automatically produced stability and tightened back up. With the tightness came the pain
Success with chronic pain is education of what normal actually feels like.
-Rajesh Khemraj, PT, OCS, COMT, FAAOMPT
Clinical Faculty Instructor at The North American Institute of Orthopaedic Manual Therapy
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