It all started when…
My first experience with chronic persistent pain was my mother. A brilliant occupational therapist (this makes me genetically 50% OT right?) with non specific low back pain since she was 17, and extraordinarily high self efficacy. She bucked the medical advice of the time and refused surgery countless times under promises from surgeons that she would end up wheelchair bound if she didn't. She ignored findings on MRIs when my uncle told her they "didn't matter". In the early 90s she was the occupational therapist involved in developing a "chronic pain program" at her hospital. She was skilled at guiding her patients to live better lives in spite of their pain. It wasn't your run of the mill "work hardening" under the guise of a pain program. Then while at work, she tweaked her knee. Two knee arthroscopies later she evolved into a significant CRPS state that had the classic trophic changes that no one recognized, this was 1999. This occurred while I was in PT school and referred to as reflex sympathetic dystrophy at the time. It was one of those diagnosis that would get assigned for class presentations when the professor wanted a sweep of "weird" diagnosis. And so began my clinical life. Right out of school I was "that therapist that knew about RSD". While I was living my "neuro" career, I remained vigilant in reading as much research as I could find. A few years later the Recognise program was developed and I guided my mom through it. When she couldn't tolerate it I graded her down to magazines and she bought chubby dolls legs from the craft store to help her in a less threatening way. She is ever the clinician and ever the patient. She has sought out every possible manual, tissue based treatment you've ever heard of and many you haven't. Her knowledge has grown too as she has learned vicariously through me. Our conversations are interesting.
I was solo on my pain knowledge journey. I went to courses, read, and practiced. But I had no one to mentor me, or hash out a patient with. I was that therapist that did weird things that the "therapist hopping" patients loved. Managers would schedule the "difficult" patients with me. I treated my patients in hiding to avoid the judgement of the tissue based masses. I would give lectures and in-service the staff and ultimately decided the best way was for me to treat in the middle of the gym and let them look and ask questions. Now therapists ask to sit in on my sessions to learn from them. These patients are complex individuals.
Let's start talking about treating them better and guiding patients to regain their power over their lives.