As a patient’s pain gets more complicated, so do their lives. The presentation of the patient is no longer just a simple acute injury that should go though the normal healing stages. A lot of times with acute injury, there is no story attached to the injury, so the healing does not get complicated. As the pain becomes more chronic, the source starts to become blurry. The longer the pain persists, the more confusion that happens, as the patient gets further away from and perhaps forgets the initial source.

If there is an acute injury due to someone causing harm to another, there is a chance of emotional clinging to the injury. The person could wonder “why me,” “I did not deserve this,” “my life will never be the same,” or “how will I get back to what I was?” As long as those thoughts persist in a patient’s mind, the greater the chance that they will not heal to their fullest capacity. The pain will carry an emotional component that has to be healed along with the physical component. The longer it persists, the more it can continue to fuel the manifestation of the physical pain. The physical damage can be healed and appearing “normal,” but when the patient is activated emotionally and reminded of the psychological hurt and pain that was caused, the physical pain can “magically” reappear. The patient then becomes hopeless due to the continued return of the pain no matter what they have tried. Failure becomes their normal. They try all the modalities, all types of practitioners, all types of remedies with no long-term success.

The key to helping these patients is recognizing the triggers of their pain. Typically, most chronic pain patients will tell you that they experience a lot of stress in life. They are unable to disassociate minor and major stressors. As a practitioner, if you are able to recognize “it is just a bad day” presentation and use it to explore the patient’s lifestyle, there is a strong potential that you will encounter the trigger of their current pain. It may take a few times of the same stress to happen before the patient will accept that a particular activity is a cause of the continuation of their pain.

The next step is helping the patient understand that they do not have to take on that stress that is causing their pain to consume them. Most will not believe you. It has become their normal, they can not see the alternative to their lifestyle. They need guidance on how to change those behaviors. This can take time because the behaviors can be so ingrained that you have to use multiple approaches to help the patient become free of the trigger. Once they can make the correlation, then they are typically self-managing of that particular problem.

This process is repeated until the patient has control of their pain. At this point, pain starts to become an indicator that there is some type of stressor that is negatively affecting them. They can use pain as a modulator of their own emotional stress and learn how to recognize its impact before it becomes overly consuming to the patient. Pain no longer is suffered, it is used to prevent further suffering.

-Rajesh Khemraj, PT, OCS, COMT, FAAOMPT

Clinical Fellowship Instructor at The North American Institute of Orthopaedic Manual Therapy

About the Author

Rajesh is a Physical Therapist, who is passionate about health and wellness. He is interested in all aspects of general well being including fitness, nutrition and mindfulness. He continues to learn and grow from the profession he loves.

If this article is helpful to you or you would like to get more information, please do not hesitate to contact me at superflypt[at]gmail.com