Hi Guys
One of the things, i found on my musculoskeletal clinic, especially in patients whose english was their second language, or they were from a different country, was how much perceptions of pain can differ. I can not be sure whether, it is their perception of pain, or just greater difficulty expressing what exactly they are feeling, as they are not so familiar with the language.
But with quite a few of my patients when i was performing my objective assessment, some of my patients would say pain to just about every direction, or every test. Sometimes it was really hard to get a good idea of patterns or pain behaviour, or just some of the things they would say just didnt add up. (This is really hard to explain to you sorry.)
For example one of my patients would say there was "pain", but it was more just a muscle stretching feeling with AROM of the Cx spine when she had reached end range and not the pain she was complaining off.
What i have learned from this, is how important specific questioning is when performing objective assesments. As things such as combined movements often cause a bit of discomfort in everyone but this is not the same as pain. I think you have to be careful to only ask one question at a time, and find different ways of asking the same thing. Try and limit your words, and ask them to describe the pain, when they are saying everything is painful and it is not an acute problem i will also try to narrow it down by asking which is the worst test.
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3 comments:
Rach
The positive aspect of communicating with patients with limited English is to be very concise and only ask the most pertinent questions. During assessment, I often include words like, "Please let me know if I touch something that causes SIGNIFICANT pain". These words tend to exclude patients reporting inconsequential or irrelevant discomfort.
Regards
John
Hi Rach, I had some similar patients during my musculo prac and i encountered some very similar situations. Whereby they either rated 10/10 pain or said that a lot of things were painful. I found that if you try stuff on their unaffected or if you are treating their spine do some random tests or stretches on their legs (which you would expect to give a stretch but not painful) to get a base line and compare it with your actual tests.
Well done, it appears that yo found some effective ways to negotiate the situations. I also found it useful to give the patient just 3 options to describe their pain level - a little bit, a moderate amount or a lot - for the movements that you would not expect to be painful, or if they report something to be painful but you believe it to be a stretch etc.
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