I have treated a patient on two occasions over the past few days for back pain complaints. Her initial complaint was primarily 6/10 pain in the lumbothoracic area, and 4/10 pain in the area of upper trapezius. I performed a relatively full assessment of the Tx and Lx spine, and the only significant finding was that she sat in excessive flexion and maximal posterior pelvic tilt. I treated this with active movement into some anterior tilt (she actually had quite good lumbopelvic dissassociation) and posture reeducation, which made her feel much better. She also pointed out to me that she believed that her interpretaion on pain is heavily dependant on how happy or sad/anxious It was a bit of an odd presentation (given that some answers to subjective questions were quite abnormal), but I just went along with what she was telling me.
I saw her 3 days later, now with 6-7/10 pain in triceps area, 5-6/10 pain upper trap, 4-5 lumbopelvic area. I was feeling pretty tired, and didn't really feel like treating a patient such as this. But then I thought to myself that the time I saw the patient 3 days beforehand I was able to make her symptoms much better - if I can make her happy, why not?
I continued on with posture corrections and education, which was effective. I did not investigate the arm pain any further, but at the conclusion of the treatment session she reported that this pain had gone or 'been cured'. I just provided her with some empowerment to help her help herself.
I later read in her notes that she had been living alone for some time and was feeling very isolated, and also at times quite paranoind.
So does it matter if you can't find a comparable sign? In this case I don't believe so. I established that posture was really the only point of concern at this stage, and ensured that I was not missing or overlooking any other factors. I just gave my undivided attention to the patient, made her feel that I was improving her sypmtoms and provided general reassurace.
Of course each case is very different and there are many factors that need to be considered. THe approach of the biopsychosocial model incorporates the notion of pain is strongly influenced by social and psychological aspects - something to keep in mind.
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I think that that is a really important point-acknowledging a person's pain can sometimes be more effective than treating it. You did really well in not getting overwhelmed and trying to analyse and treat her different areas of pain-but stepping back and looking at the whole picture and treating her as a person and not just an "arm" or a "back". It's something we all need to keep in mind when assessing and treating patients-no matter what field you're working in.
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