Welcome to my first official blog post. I'm going to go out of order because it's important. If you’re reading this, chances are you're beginning your journey into understanding and treating patients with chronic persistent pain. If I could give only one piece of advice to those starting out, it would be this: help your patient find joy. There isn't a magic exercise or manipulation that will make them feel better. But harnessing their "happy" can help a lot. Now, you may be thinking "Wow Devra, real helpful advice you're giving there". Let me show you how to do it, and document it.
During your evaluation you are going to ask questions, listen attentively to their answers (more on that in many future posts), and evaluate some stuff (more on that another day too). But when you are getting to the end of your time with them, you give them their first "home exercise program". Here it is: find joy. With chronic illness, people can lose their sense of self. Regaining joy through engagement, is vital in resolving this. Find what makes them laugh, smile, chuckle, chortle, guffaw, grin ear to ear, whatever. Serotonin and dopamine are the antithesis to danger. Use them. Whatever it is they identify, help them find it so it is accessible to them. Educate them that they are to use that throughout their day, but particularly if their symptoms increase. This will be their first tool for self management. Implicit in this task is the message that they have the power to have some impact on their symptoms. I've had patients who love looking at pictures of their grandkids, pictures of flowers, watching comedians on YouTube, reading the Sunday funnies, drawing, looking at cool architecture, the list goes on. I spend a few minutes helping make that thing attainable. This may mean you help them google it, as some are not as computer literate as others. I've shown patients the wonders of YouTube, printed drawing pages for them, printed pictures for them, and helped them search apps that are free. And for those patients that tell you they don't like anything and nothing is funny, tell them to laugh 5 reps, 3 times a day. And then demonstrate it for them. I'm not kidding. It can illicit contagious laughter.
Here is how I document it:
Objective: Strategies for self management: patient identified drawing as something they really enjoy. Patient likes drawing flowers in particular. Coloring book images of flowers were googled and patient selected images that they preferred and they were printed. Patient further educated on how to look for free phone apps, and save images found on the internet. Patient was instructed to draw/color daily and if they are unable to draw/color when they feel they really need to, then visualize drawing/coloring a favorite image. Patient re-verbalized understanding.
Assessment: At present, patient is not aware of any strategies that can positively impact their symptoms. Therapist facilitated finding a strategy for self management and implementation of strategy. Subsequent sessions will work to expand this further.
First session after HEP:
Subjective: Patient reports attempts at using drawing as a strategy on 3 days. She however had a hard time finding the time to do it.
Objective: strategies for self management: Patient noted that setting aside time to draw was cumbersome. Patient shown YouTube videos of people drawing flowers and educated to save/download video. Patient was additionally reminded that she can visualize drawing a favorite image.
Charmaz, K. (1983). Loss of self: a fundamental form of suffering in the chronically ill. Sociology of Health and Illness, 5(2), 168–195.
Dunbar, R. et al. (2012). Social laughter is correlated with an elevated pain threshold. In: Proceedings of the Royal Society B: Biological Sciences.
Takai, Y., Yamamoto-Mitani, N., & Chiba, I. (2017). The Process of Motivating Oneself to Resist Being Controlled by Chronic Pain: A Qualitative Study of Japanese Older People Living in the Community. Pain Management Nursing, 18(1), 42–49.
Tse, M., Lo, A., Cheng, T., Chan, E., Chan, A. and Chung, H. (2010). Humor Therapy: Relieving Chronic Pain and Enhancing Happiness for Older Adults. Journal of Aging Research, 2010, pp.1-9.