This week, I decided to skip the questions I have been asked recently and focus on an event that happened to me recently.
I have a patient who came in to see me for pain control. The patient has had a rough few months after being diagnosed with cancer, undergoing chemotherapy and then developing shingles on top of it all. She and her husband have struggled to find a way to give her relief from her pain and the distress all these events have caused.
On the first visit, we mainly talked, and I proposed something to her that seemed almost too difficult for them to believe. I said that I was sure she would feel better. I said there was no way for me to be certain if her pain would go away completely, but I was sure that the intensity of her pain would be lessened.
This is not the first time I have stuck my neck out there to make such a bold statement, but for me it is grounded in fact more than fantasy. I readily admit that I am not the smartest therapist out there, and having met a lot of very intelligent and gifted medical practitioners, I have come to realize that I am not as smart as a lot of my colleagues. What I will say – to pat myself on the back – is I am good at the obvious and the basics.
This may not sound like it is all that impressive, but I have to toot my own horn for a minute and say that I have built my career around this type of therapy. I have found the vast majority of people have straightforward and basic conditions that match common sense and basic physiology.
In modern society, we have information overload, and certain shows on TV have huge audiences tuning in to the shows that highlight the rare and extreme scenarios because they are far more dramatic and entertaining. I myself enjoy those shows and certainly read almost daily about the medical research in the news and in the journals I subscribe to.
I have stayed true to the basics and I have honed my skills to notice the basics and ask questions that confirm or deny my working hypotheses. So when I boldly told this couple that I was sure her pain would improve, I wasn’t offering false hope – I was playing the odds and following physiology and in particular the adaptability of the body and brain.
This woman’s pain would improve without any intervention because pain is merely an impulse that goes to the brain for interpretation. Initially, the brain interprets the events as “big” impulses, and the intensity of the pain is high. As the repetition of the impulse comes in, there is a dulling effect – in most cases – that leads to less pain.
I also asked the basic question if she was able to fall asleep at night, even if it was momentary. She said yes. So now I had proof and direct evidence for her to use in the future. The fact that she experienced sleep means somewhere along the way her brain and body figured out a way to block her pain long enough for her to fall asleep, and while asleep she had no pain.
I like to “prove” something is true or not true. Very few things are “100 percent true,” which means there will be exceptions. So when she tells me that she “always” hurts, I find out what happens when she falls asleep, and I learn she has no pain then. This means that she doesn’t “always” hurt, which means her body and brain already are working on a solution to reduce her pain.
I think it is important to bring this up because a lot of the time we get stuck, so to speak, where we believe, totally, something that is only partially true. This leads to frustration, and our focus narrows, so we struggle to find solutions.
In their desperation to find relief, the couple has focused only on specific concepts and treatments, and unfortunately they did not help.
By focusing on the basics, I was able to start the process of guiding her to a reduction in her pain. I am not going to do anything to help her other than guide her back to what her body has already shown her. ?
My job is to be the guide; I have the basic plan, and for most part, it is a good place to start. If the terrain becomes complicated, then at least the basic plan has clarified what the solution can’t be.
And sometimes, when we are dealing with debilitating conditions, that is not only the first step but it is the only step needed.
If you have been dealing with a lot of pain, there is hope and relief is available. I don’t say people will be pain-free, because it may not be realistic and pain is not the enemy – it is merely pointing you in a direction – and those individuals who truly feel no pain usually die young because the help we all get from pain is not available to them.
So, as with this couple, I can boldly say the intensity of one’s pain will decrease with time, and if you are stuck, find someone to guide you through the process of feeling good again.
Gloversville native Matthew Goodemote is the owner of Goodemote Physical Therapy in Saratoga Springs and Community Physical Therapy & Wellness in Gloversville. Readers may write to him via email at [email protected].