I once saw a patient who was involved in a motor vehicle accident and suffered from whiplash. The accident left her with neck pain, arm pain, low back pain, and leg pain. I mean everything hurt. The car wreck was a couple months prior to our first meeting, so I would expect that some symptomatic improvement would have occured by the time she walked into my clinic. (The tincture of time can usually help painful orthopedic conditions.)
Whenever I meet with a patient, I ask a lot of questions that help me decide on the best course of action to help the patient. Is this problem acute? Dangerous? Are there some clues that tell me there may be some barriers to treatment? Is the patient anxious about moving again? Are there any issues related to possible secondary gain?
One question that I ask is about the nature of the pain. Is the pain constant or intermittent? This question helps me determine if there is an inflammatory condition present, or if the person's pain is mechanical in nature. Typically, but not always, constant pain is likely inflammation, while intermittent pain is likely mechanical.
Sometimes, constant pain, especially diffuse constant pain, that has been present for a long time can be a sign of a barrier to treatment. Like I said, many orthpedic conditions get better with simply the passage of time. If you stub your toe it will hurt for a few days. That initial inflammatory pain will likely be constant in nature. After a few days, the really bad pain will subside, and then your toe will hurt only when mechanically pressed upon. After a few weeks, with no outside help or treatment, your stubbed toe will return to normal.
This particular patient told me that her pain was constant. It never went away. If someone tells me they have constant pain, I usually ask if the pain changes-does it get better or worse throughout the course of the day? When I asked my patient if her pain gets better or worse, she told me that it gets worse, but never better.
How could that be? How can something get worse as the day passes, but never get better? I had to ask. My patient answered that her pain ranges from "worse" to "not as worse."
Hmm. We have a problem. This particular patient was viewing her pain and her problem related to the car accident as something that doesn't get better, just not as worse. The fact that she saw her condition change like this on a day to day basis tells me that there may be a bit of a barrier to treatment here. This patient may be suffering from non-mechanical chronic pain.
Physical therapy can help chronic pain sufferers, but I find my personal outcomes are better if I can find a mechanical solution for the pain. If I can find a cause-effect relationship with the patient's movement and her pain, then my ability to help is greatly increased. If a patient sees her condition as "worse" or "not as worse" then I may have a challenging time in helping her return to normal function.