This blog concerns my orthopaedic prac. The pt involved had a nail inserted into her femur roughly 12/12. The ORIF caused an infection and progressively her pain increased to the point where she was on the strongest pain control able to be tolerated. Of course her body developed tolerance to the analgesia’s and started having no effect on her pain level (or very minimal). The pt had to undergo a 2nd operation and have a bone graft and the nail removed from her femur.
I saw her day 1 post-op this operation. She was reluctant to mobilise as any movement caused her immense pain from the looks of it. She had pain cover prior to PT but the effects as I had mentioned her minimal. Myself and my supervisor managed to convince her that she needed to move today and she attempted to reluctantly. On starting to move from supine to SOEOB she started sobbing uncontrollably and then preceded to cry.
I was taken aback, my supervisor tried to encourage the pt and make her stand up. I had mixed feelings about the pt’s response. I was questioning whether she was being ‘brave’ or ‘dramatic’. My supervisor and I discussed later what had occurred and she gave me some advice on how to manage this patient.
After that experience i was keen to learn about tolerance to pain medication. I saw her subsequently by myself for the next 4 days sometimes x2 daily, iIam happy to say she improved dramatically though would still be in a lot of obvious pain at time. I educated her alot regarding her pain and tried to enforce what we were doing was not harmful and she would benefit from this intervention in the long term. Her trust in me developed and she made progress with each session. I gained alot by working with her and the experience helped me understand from a pt’s perspective the concepts of pain and pain cover. In addition and equally important I found that we as physio’s can really influence our patient’s through education and developing a good rapport with them. If you do this successfully they will trust your judgement and will feel more empowered with each gain they make per session.