I am currently on a neuro outpatient placement and treated a patient last week, 1 month post-stroke. When I commenced treatment I started with SIMMS of the lats and pecs. The patient was grimacing from time-to-time whilst I performed these techniques. I asked if everything was ok?, etc, am I hurting you? She would reply that it was a bit sore, so I would reduce my contact in all aspects. She also did the same when I came to tactile stimulation of the hand. I was using various instruments which I thought would not evoke those responses. From the start of this behaviour I would encourage the patient to relax, breath deeply and slowly and while she took this advice on board she still would get slightly upset every-so-often.
I knew their wasn’t much more I could do rather than provide inadequate treatment if I couldn’t continue. She just appeared to have allodynic tendencies. What I noticed about the treatment session was that she could tolerate the techniques so that at least made me feel like I wasn’t hurting her and it was not sustainable pain, i.e. it disappeared as soon as I stopped or reduce the intensity of contact. This was an interesting experience working with this patient. Before this I had no idea what these patients would present like and how they would react to treatment they perceive generates a level of pain to themselves.
I guess every patient will be different in this regard, though you could almost assume that for rehabilitation to occur for a patient such as this we need to get our hands on them and make them feel as calm and comfortable as possible.
In the future I will perhaps get similar patients to rate their pain (0-10) if I perceive they display the same tendencies. That way I can ignore the lower levels, after briefing them regarding this, but back-off the technique on the perceived higher levels they respond with. What are some strategies that you have used in this kind of situation?
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Hey, i've never really come across a patient like this but i find it very interesting! Pain really is a very interesting topic and it's really hard to judge because everyone perceives it differently. Sometimes the treatment that you carry out may seem to be one that will not cause pain, but to these group of patients, you cannot imagine the type of pain that they are going through!
I guess, because pain is so subjective, using the VAS scale would be a great idea to gauge how far you can push your treatment to. But the patient has to understand how this scale works so before starting, a detailed explanation would have to be given and the patient has to understand it well. I actually heard of an objective way of measuring pain using some kind of pressure gauge, but i'm not sure if it applies to neuro patients. Anyway, hope my comment helps! All the best for the rest of your placements!
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