patients - Back in Control https://backincontrol.com/tag/patients/ The DOC (Direct your Own Care) Project Tue, 27 Aug 2019 16:38:47 +0000 en-US hourly 1 Anger-The Absolute Block https://backincontrol.com/anger-the-absolute-block/ Thu, 05 Jan 2012 15:18:14 +0000 http://www.drdavidhanscom.com/?p=2716

It has become clear that if a given patient engages in the principles outlined in this book, he or she has a high chance of experiencing a dramatic decrease in pain and improved quality of life at some point in time. The richness of this new life often exceeds anything … Read More

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It has become clear that if a given patient engages in the principles outlined in this book, he or she has a high chance of experiencing a dramatic decrease in pain and improved quality of life at some point in time. The richness of this new life often exceeds anything experienced before the nightmare of pain began. It is not a matter of “if” the patient gets better, only a matter of “when.” There is not an exact roadmap, and often other resources fit a given person’s needs better than what I have suggested. The key is to first address the anxiety, then the anger, and continue to “shift” the nervous system into a more functional set of circuits. The plan must be somewhat structured and consistent to be effective.

Anger

Nonetheless, there are obstacles to becoming pain free. The absolute biggest block that I encountered daily was anger. I honestly didn’t know how to help a patient get past it. He or she becomes irrational. When you are chronically angry, it is your baseline, and you cannot even recognize that you are angry. I personally had no clue that I had any anger issues until I was 50 years old. In fact, one of the first lines to my wife when I first met her was that I was a “good catch” because  I had dealt with all of my anger issues. I am glad that neither of us had any idea that I had not even opened the door to my frustrations, as we never would have made it.

Noncompliant

The problem with anger is that you cannot listen and accurately assess a given situation. The conversation I have with a patient who is noncompliant goes like this. “Doctor, you mean to tell me that there is nothing wrong with my back? I have been in pain for several years and I know that this pain is not in my head. You must be missing something.”

I reply, “The pain you are experiencing is not imaginary pain, nor is it psychological. We know that if we did a functional MRI of your brain right now, the part of your brain that corresponds to your area of pain would light up brightly. All that matters is what is happening in your brain. We also know that the brain can fire spontaneously without an indentifiable source of the pain. I don’t just believe you have pain–I know you are experiencing pain and are frustrated about being trapped.”

 

L0000385 Anatomical expression of rage. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Anatomical expression of rage. 1806 Essays on the Anatomy of Expression in Painting Bell, Sir Charles Published: 1806 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

 

I also explain to them that degenerated discs are normal as you age and that there is no correlation between a degenerated disc and back pain. The surgical success of a fusion for LBP is less than 30% with a significant downside of a failed surgery. They then say, “I don’t want surgery. I just want to be fixed and get my life back.” When I reply that we have had very consistent results following the steps outlined in this book, they explode saying, “I don’t want to read a book or anything like this. Just do something to fix my back.” They will then start ranting and often even yelling that no one will help them. Occasionally they will walk out of the room.

Anger is an absolute block to moving on

This is a frequent scenario. I would estimate that at least 50% of my patients fall somewhere in this part of the spectrum. They are noncompliant actually not by choice. I realize that chronic pain causes anger, but It is this anger that is also a complete block to engagement in effective treatment. Anger is destructive and it is multi-directional. It is particlurlarly self-destructive. You also have a strong sense of “being right” when you are angry and an even stronger sense of everyone else “being wrong.” I honestly do not know what to do to break this mind set.  I have tried everything from being confrontive to being incredibly patient. Nothing has worked. In fact, I have found that the longer I spend trying to convince someone to engage, the angrier they become. Angry people become upset when trying to be convinced to give it up. They just cannot hear me.

Address Your Anger

If you are angry or living in one of the above disguises of anger, be careful. You are trapped. You are truly stuck, and no one can even throw you a lifeline. What you cannot see is the havoc you are wreaking on those around you and onto yourself. I do not know how best to quell the anger rooted in chronic pain. I am open to suggestions.

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The “Five E’s” of Chronic Pain https://backincontrol.com/the-five-es-of-chronic-pain/ Sun, 27 Nov 2011 15:30:13 +0000 http://www.drdavidhanscom.com/?p=2448 A few weeks ago, I sent the roundtable a short article I put together called “Ability and Motivation.”  These are the two key ingredients necessary to create true change. My point was that the current state of the worker’s comp system destroys both of these attributes.  The only logical choice … Read More

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A few weeks ago, I sent the roundtable a short article I put together called “Ability and Motivation.”  These are the two key ingredients necessary to create true change. My point was that the current state of the worker’s comp system destroys both of these attributes.  The only logical choice in light of the complexity of any worker’s comp system is to arm the worker with these tools.

There was a discussion last year that led to a document called “The Five E’s of Chronic Pain.”   They are:

  • Empathy
  • Evaluation
  • Education
  • Encouragement
  • Engagement

All of these are geared towards enabling and motivating the patient to take charge of his or own care.

One E that I want to emphasize in particular is education   it’s critical for several reasons.  If a given patient is willing to immerse him or herself in learning about all of the variables that affect his or her pain, the chances of them eventually improving is extremely high.

Conversely, if they are not willing to read, listen, and learn, then they cannot and will not get better.  They must be willing to take on that responsibility.  Otherwise they are choosing to remain in a victim role and will remain angry.  It is also difficult to work with them, which also makes progress unlikely.  I think it is important for those working in chronic pain to set personal boundaries while still “keeping the door open.”  If you are attached to getting that resistant patient better in spite of their wishes, you might get yourself into a very unhappy, energy-draining situation.  You need to let them go.

I just put on a mini-seminar called “Enjoying the Management of Your Chronic Pain Patients.”  Once a given patient decides to fully engage, it is like opening the door of a caged wild animal.  You cannot stop them from regaining their life.  It does not matter how long they have been in pain. Working with these patients has become the most rewarding and enjoyable part of my practice.

NH, BF

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