Psychological Factors

Whilst on my musculo placement, I was given a patient from the previous student that had initially presented to the clinic the previous month complaining of chronic pain that affected her whole body. The elderly patient described 9/10 to 10/10 pain in her neck with extensive loss of mobility. Her past medical history was extensive including chronic dermatitis, coeliac disease, IBS, hypotension, claustrophobia and agoraphobia, which causes a severe fear of social situations and distrust of people around her.

On her first treatment session with me, the patient displayed extreme anxiety walking from the waiting room to the treatment cubicle and began to, what appeared to be “hyperventilating”. Knowing her history with hypertension and anxiety, I gave her a seat and closed the curtains around the cubicle to block out the distraction of the other students and staff. Thinking that this would relieve her anxiety, she appeared only to get worse and reported that having the curtains touching her made her feel sick. As such, I opened the curtains and moved her to a cubicle that was adjacent to a door where she could see an exit. Her anxiety started to decrease and she began to elaborate on how active she had been in her 20’s, seemingly avoiding all the AROM assessments and exercises.

I didn’t want to appear rude and interject as she already has a chronic fear of trusting people however, I was frustrated that I was unable to perform any hands on treatment with her as every time I attempted to make contact, even if I asked permission and warned her, she displayed a hypersensitive reaction. I learnt that the best thing to do was talk to her during the first treatment session and slowly gain her trust. Over the 5 weeks that I saw her she told me that I was the only person that she allowed to treat her and gradually I was able to perform more invasive neck mobilizations. She seemed grateful that I took into account her phobias whilst treating her and slowly her AROM improved to near FROM and her resting pain became negligible.

I learned that her psychological conditions were feeding a fear avoidance syndrome and contributing to her chronic pain and that getting her to understand this can prove to be extremely challenging. In these circumstances pain scores are not useful in determining progress rather ROM, confidence and developing trust are better indicators. Encouragement was crucial and distracting her with conversation and getting her to copy movements I was performing was one way in which I was able to help her realise not to be afraid of movement.

In the future, I will have a better understanding of how to treat patients using a more multidisciplinary and personalized approach. It is ok if no treatment or assessment is performed on the initial visit. Building a relationship with the patient is the basis to any successful intervention.