Chronic Pain — The Power of Language
Recently I posted on social media a page from the latest Brukner and Khan textbook (Clinical Sports Medicine) listing all too common phrases that you might be used during a consult. See below:
Yes, very unique that Lorimer. However, I think it is fantastic that pain science is now being taught at University’s and would like to add a few tactics that I have found helpful when working with an individual with chronic pain. References at bottom of page.
The ICE Principle
Ask three simple questions.
Idea: What is your idea about what is going on?
Concerns: What are you most worried about?
Expectations: What are you expecting I can do?
Some fantastic resources for everyone to enjoy. I carry a copy of ‘Protectometer’ with me so I can use it at each location when required. I especially like working through DIMS and SIMS and setting this as a homework task to gauge understanding.
The NOI group (Lorimer Moseley and David Butler) also have some very user friendly videos which I will commonly direct people to as required viewing. They are both entertaining and informative.
*Both videos came recommended by Dr Peter Braun.
The Kieran O’Sullivan Test
“Ask your patients to describe how they will explain your consultation to their family when they get home.”
If you are not sure if your patient understands or is simply agreeing with you, this is a great way to ensure you are both on the same page.
I am constantly drawing jigsaw puzzles to explain the wide range of factors influencing pain and the relatively small (but vital) role that exercise can play. I find this incredibly helpful to increase the understanding that there is no silver bullet, but encourage working on achieving small goals across many areas. Taking the time to treat your communication as an art rather than a science can really help increase understanding as well as build rapport.
The Exercise Advantage
As exercise physiologists, we have the advantage of having ‘exercise’ in our title. This can be a bit of a barrier as some people are intimidated at the thought of exercise and don’t turn up for their appointment (these people need to be told how lovely we are). However, the Exercise Advantage allows us to gently encourage people to start moving (throw them on an exercise bike or similar) and have the pain conversation openly, while they are moving, which we know makes them feel better. This way they are happily distracted and creates a nice open forum to discuss pain without judgement.
Brukner and Khan, Clinical Sports Medicine, January 2017.
ICE principle: Excerpt from Medical Republic, Dr Gurpreet Dhaliwa
l, University of California.
DIMS and SIMS: https://noijam.com/2015/03/12/dim-sims/
Pain Ed: http://www.pain-ed.com/public/