pain pain go away

I am currently treating a patient who was involved in a MVA and sustained fractures to C3 and C4 vertebrae. Consequently the patient has now been in halo traction for 3 of 6 weeks and is classified as a C3 incomplete tetraplegic. This patient has a brown sequard type presentation where there is ipsilateral weakness and contralateral reduction in sensation. On assessment, the patient reports having left sided numbness and occasional burning sensations down the back of his legs.

This patient is routinely 'turned' (moved onto side briefly while the turning team rub the skin) and repositioned to prevent pressure areas every 2 hours. Every day i have been treating this patient, primarily to maintain and strengthen innervated muscles of the weaker side as much as the supine position can allow using active assisted and active resisted methods.

One morning as i began my routine treatment, the turning team came in and i asked if they could come by this room last as i only have an hour allocated for ward patients. The patient then told me that he hadn't been turned since 2am. Reason being that the patient was fine to be left as his neck was comfortable and alignment was fine at 4am and then the 6am rotation never came. Within the first couple of minutes of treatment whereby i moved the patient's left arm from by his side, to abduction and supination the patient complained of excruciating burning pain down the medial side of the forearm in an ulnar distribution. Knowing this patient is extremly tolerable to pain and never complains, i knew this was severe. No position or movement relieved the pain, only aggrevating it more. I asked if had this pain before, he said "occasionally, but never this intense or for so long". His neuro meds had only been administered 10minutes before. I checked with my supervisor to see if there was anything i could do and only medication and possibly gentle movements will relieve the pain. 15 minutes later and gradual introduction of movement the pain eventually reduced to a tolerable level.

I felt quite helpless in this situation, as i couldn't provide the patient with a definitive answer on how long the pain will last. The pain team was alerted of this event, but re-assessment wouldn't be possible until the afternoon. Even though i was unable to make the pain go away, i was able to reinforce the importance of regular turning. this nerve pain was most likely brought on by the patient's arm resting on the ulnar nerve for a prolonged time (7 hours) as he missed 2 turns. Especially as that arm is weak and not moving. In addition the patient was educated on how the increased pressure on the nerve for such a long time may lead to neuropraxia (nerve damage) which will further stunt recovery. He is now aware why changing position is not just for realignment and that he can take responsibility to ensure moves his arms and legs regularly.

This event has reinforced how important patient education is in compliance and understanding treatment. As the turning teams are constantly changing, it is hard to grasp the full picture of each patient due to time constraints. However i think it is important that they take the time to thoroughly educate the patient and consider their approach to patients. Perhaps "If it is ok with you, we are going to turn you now" instead of "would you like to be turned?" which reduces the importance of the act. I can also reflect on how frustrating for the patient it must be to be turned every 2 hours, but a little education can help ease the situation.