Goal of the Study?
Every day, patients present to clinics worldwide and report pain, discomfort, and stiffness to their providers. These people also can be labelled as ‘chronic pain patients’. An interesting paper was published in BMC Musculoskeletal Disorders1 where researchers worked to try to understand what these words meant to the patients to help the providers learn more about the patients and their reported problem(s) in a clinical setting.
Why are they doing this study?
Clinician-patient communication is the often the vehicle that guides the differential diagnosis and associated treatment path. If a patient’s perceived sensations are not effectively communicated, or if a clinician is not asking appropriate questions about their complaints, care plans can likely go off track and lead to poorer outcomes.
What was done in this study?
Fifty-three chiropractic patients filled out an online survey to describe what ‘discomfort’, ‘pain’ and ‘stiffness’ meant to them in their own words. The researchers then created a mapping of the descriptive words the patients used in a lexical and inductive content manner.
What did they find?
The characteristics of the patients included 47.2% females with an average mean age of 39.1 yrs. They were receiving care for head(7.5%), neck(47.2%), shoulder(41.5%), upper extremity(15.1%), mid-back(34%), low back(54.7%), hip(26.4%) and lower extremity(30.1%) over a < three months period(24.5%)/> three months period(71.7%).
Below you can see the mapping of the words they chose in Fig 1. Quite the array!
Why do these findings matter?
Doctor-patient communication is critical in chiropractic and other health care provider settings. If patients report symptoms with words that a clinician cannot interpret, the clinical encounter can derail. This research question is fundamental which can help doctors understand what patients are telling them. Paying closer attention to a patient’s complaints can bring clarity to the sources of a patient’s pain and guide the respective care plan. Congratulations to the authors for this important work.
Clinical encounter experience by Jerome Fryer (JF) below ↓ with a potential utilization strategy of the Pain Meter
JF shares his experience from June 1st, 2022:
Patient, female, 36-year-old, spent her youth as a dancer up until 18 years old, now a dental hygienist.
Pt. “I have chronic pain” “I get headaches”
JF “What is the area that is most problematic for you?”
Pt. “My neck”
JF ” What is it that you are experiencing about your neck”
JF “Is it stiffness or is it pain that you feel in your neck?”
Pt. pauses and looks at JF in a confused manner “It is stiffness”
After evaluating the patient’s cervical spine AROM, no movement was found to be limited in any direction. One interesting report was when she over-rotated her cervical spine into left rotation (this information was volunteered by the patient), there can often be a ‘click’ sound with local upper left cervical pain following.
This spoke to a greater theme of her self-awareness and self-care of her own cervical spine and likely other joints , JF thought. As a father of two dancers, he understood the emphasis on flexibility of all joints in the human frame.
Upon palpation of the cervical spine (patient lying supine with posterior to anterior pressure with JF’s index), there was a peak tenderness of the C3-4 level while using the pain meter. See video below on what the pain meter is.
New Pain Meters are on backorder. Click here if you are interested in purchasing one.
In this case, JF educated the patient about his findings and helped the patient understand that not all tissues need to be flexible. In other words, he explained that ‘stiffness’ is not a bad thing in this case. Using all the clinical information he believes to have revealed excessive movement most notable at C3-4 level using the pain meter. With this, he instructed the patient NOT to intervene with neck stretches upon the first sensation of ‘stiffness’. Instead, he advised the patient to give it time rather than to intervene with a self-stretching movement. A therapeutic approach to mobilize the lower cervical segments (which were non-tender) encouraging more motion of the lower segments to motion-share the global movements of the cervical spine was targeted. Historically, the patient (as a former dancer) had always thought of flexibility as the foundational solution to her issues. Up until now, she had always addressed her chronic pain and headaches with stretching. This stabilizing concept of the upper cervical spine and mobilizing the lower cervical spine was new to her. Using Dynamic Disc Models as part of the education helped her understand over-flexibility.
At Dynamic Disc Designs, we create dynamic human anatomy models to help patients of neck and back pain, understand the sensations they feel as it relates to their musculoskeletal complaints. Stiffness is not always a bad sign and our dynamic disc models can help shed light on the often, natural healing of these deeper tissues.