CLINICIANS GET CREATIVE

Transcription

1 By Paul Lagerman Physiotherapist CLINICIANS GET CREATIVE Creative Ways to Reframe Pain

2 Ready to engage with people living with pain in a creative way? 'At a time when health professionals need to cope with a growing number of complex and chronic cases, the ability to appreciate the subtlety of language use, such as metaphor, can enable health professionals to work comfortably with the complexity and uncertainty involved in modern medical practice. ' Stephen Loftus PURPOSE OF THIS ebook This ebook has been developed through submission of creative material from international collaborators, and whilst it may seem limited, further updates will continue as we invite more clinicians and people living with pain to submit their creative ways of how to reframe pain. It has been developed to assist clinicians by embracing alternative ways to educate people about pain. WHY SHOULD YOU READ THIS ebook? Clinical practice has required clinicians to have a broad understanding of rehabilitation approaches, pathophysiological presentations, and other treatment approaches. This too is necessary for ways to reframe pain. Having a number of creative means to reframe pain is bene cial for both the clinician and the person living with long term pain as it provides broader understanding Talking about the nature of pain can be tricky. Providing the right information to our patients is also tricky and sometimes we might feel under-prepared or inadequate to talk about dif cult and complex issues, particularly when it comes to pain. So to help you with your communication here are some creative ways to reframe pain. The images are not in any particular order, they are just a small collection of images I use on a day-to-day basis. You are welcome to use these images with your patients provided the source of the material is referenced. Page 1

3 PAIN IS... = Socratic discovery about someone's pain This image helps to open up socratic collaborative dialogue with your patients. Ask the question: What does pain mean to you? All responses are valid as pain is a subjective experience. It helps to conceptualise the many dimensions of pain. The common & strange sensations, the thoughts and emotions, the restrictions and dif culties it creates in our lives and the dif culty in explaining pain to others who do not. It's aim is to evoke a collaborative dialogue between clinicians and patients. Finally, it can help to connect with people at a deeper level. Further questions you might want to ask are: What do you understand pain is? How does pain make you feel? How do people respond to you? 7 creative ways to explain pain Page 2

4 See the bigger picture = Scans don t tell you the full story The Scream by Edvard Munch This image provides a creative way of helping people understand their medical imaging scans. It attempts to broaden a person's thinking to other aspects in their lives that could be contributing to their pain. By zooming into one aspect of the image (small cut out on the left) it tells you very little about the overall picture. We naturally make assumptions about what it could possibly be. If we then zoom out and see the image for what it truly is it tells us so much more. Medical imaging doesn t provide a true picture of why someone is experiencing pain. Page 3

5 Caravaggio vs Picasso painting = Explaining smudging in the brain Submitted by Karen This image is useful when describing the smudging effect that can happen in the brain with pain. Compare the details in the Caravaggio painting right down to the de nition of the ngernails on the hands of the boy. This is what the sensory part of the brain sees when it is ring on full strength. Then compare the Picasso painting, the outline of the body is much more dif cult to make out. Everything seems to be obscured making it dif cult to outline of the body. This is what happens in your brain when you have a persistent pain situation. The brain can t seem to make out a clear representation of the part of the body. This can also help to explain why the pain seems to move around. Page 4

6 The Devil and his Minions = Pain has a mind of its own Pain (devil) he s a crafty little beggar! Pain can often have a mind of it s own, stopping you from doing things around the home or with friends or family. It almost seems like he has control and boy does he let you know about it when you do too much. Sometimes his minions can be around your body giving you a sharp stab when and where you least suspect it. This can help to explain the randomness and spontaneous pains that can occur. By regaining con dence and building your tolerance you can slowly take control of the devil and reduce him to the annoying little pest that he is. Page 5

7 The Dark Room = Dealing with painful movement Submitted by Cory Dealing with painful movement is a lot like getting out of a dark room. Standing up and running with the hope that you end up outside of the room is probably just going to end up with you hitting a wall. On the other hand, you can t just sit in the middle of the room without moving. If you want to get out of the dark room you ll have to explore. You would get up and carefully feel for a wall and then gradually feel around until you came to something familiar like a light switch or a door. If you just ignore the pain and go hard, you ll probably hit the wall. At the same time, if you avoid movement altogether, well then you aren t going to get anywhere. You have to thoughtfully explore the edges of your available movements, looking for opportunities for expansion. However, the doors are stuck and may even be locked. This is like chronic pain where an exit door has proven elusive. It doesn t mean it s not there, but it s not likely to be found or opened quickly. Page 6

8 The Pain of Command = Coupled habits or associations The brain is always looking out to protect you and because it is so clever it helps us to form coupled habits or associations which essentially makes us more ef cient in our daily lives. In some situations associations are formed in order to protect you. There is where the brain controls the Pain of Command. If we have certain beliefs about a moment say bending, we may couple or associate pain with that movement and hey presto a habit is formed! Any activities that involve bending no matter how small the object is we are likely to adopt speci c behaviours. In this case keeping our back straight when lifting all objects light or heavy to avoid bending and feeling pain. We can use Graded Exposure to uncouple the beliefs that are associated with certain movements or activities. Page 7

9 In times of crisis be prepared = how to manage flare ups Earthquakes, they are pretty unpredictable, they can be weird and variable. They can be invisible and have a level of uncertainty to them, most seismologists would say they are pretty complex. Hmmm, those words look familiar? Funny that! At times of a potential earthquake it s important to be prepared. People are advised to buy an Emergency Survival Kit, which might contain ares, silver blankets, food rations, face masks and gloves and other stuff to hep you live through the crisis. This is a metaphor to help people make comparisons to pain flare ups. Help people living with pain be prepared by discussing what they can put in their Relapse Response Kit. A few examples might be: Mindfulness, gentle activity, medication, a hot water bottle, distraction, chocolate. Try and avoid poor coping strategies such as alcohol. Page 8

10 SCALE MOUNT VALUE Climbing Mount Value is based upon scaling the mountain of activities that are meaningful to the person. Each of the camps represent an activity or something the person wants to do. Put the things they least want to do at the bottom of the mountain, then add the more complex and challenging ones closer to the top. The person chooses where to start, preferably at Base Camp. The clinician supports the person to approach each activity. It's important to highlight that as the person moves up the mountain it's ok that they come back down. Cognitions and physiological changes still occur irrespective of where you are on the mountain. This takes away the pressure of goal setting and the sense of setting someone up to fail. One final point - watch for those safety behaviours Page 9

11 THANKS FOR TAKING A READ! I hope the ebook helped to spark your creative side. The ebook contained just a few suggestions to help you get started with reframing pain to people living with pain, to friends and family and even to other medical professionals. You could even try making up your own! Over the coming months I hope this ebook will continue to expand with more and more additions from international collaborators. Remember, If you do decide to use them or adapt them please remember to reference the source of the material. We would love to hear from you regarding suggestions, contributions and your experiences with using the above material. Good Luck! Paul Lagerman Physiotherapist Creator of Clinicians Get Creative Contributors of this ebook (submissions welcome): Mike Physiotherapist, U.K Cory Physiotherapist, United States Karen Physiotherapist, United States Bronnie Lennox Occupational Therapist, New Zealand Page 10

12 This ebook is also available for kindle. me if you would like a copy. Page 11