Dynamic Chiropractic Canada – October 1, 2014, Vol. 07, Issue 10

From the Other Side of the Table

Understanding patients in pain: personal lessons.

By Joel Lindeman, DC

"Pain is the great teacher of man-kind. Beneath its breath, souls develop." – Marie Von Ebner-Eschenbach

People come to us to gain freedom from pain, to feel better, to live better. As D.D. Palmer stated, "We Chiropractors work with the subtle substance of the soul." Therein also lies the rub. We see so many wondrous things in our offices on a daily basis that we often fail to deeply realize how our patients truly feel.

We do a magnificent job of attaining quantifiable information in a consultation and examination. We find the subluxation, the cause of the problem, and we adjust it, restoring normal nerve flow and allowing the body to heal. We know it takes time. But do we embrace what is at stake for each individual?

We don't focus on the symptoms; we care more about the cause. However, we can learn a lot from pain. I have had the tremendous fortune – yes, fortune – of sustaining an injury that taught me more about how to be a better doctor of chiropractic than I could have ever imagined. Here's what I learned.

Pain 101

Pain sucks. I learn quickly: nociceptors are like the Energizer Bunny: they keep going and going even when I can't. Our textbooks don't make that clear enough, so let my herniated disc at C6/C7 shed some light.

Lightning pain in the back of the shoulder. Numbness in the index finger. Stabbing pain in the forearm. Deep, unrelenting pain behind the scapula. Constant, aching in the back of the neck. Electrical shock-spasms jumping through the triceps. Throw all of these in a pot, stir and drink; an ever-shifting brew of torment.

Sleeplessness 102

Nerve pain is constant. How can I sleep when I can't lie down? I try to sleep sitting up by resting my head on stacks of pillows. Most nights, I wake every two hours, and if I am lucky enough to get four hours in a row, the intensity of my pain climbs higher. So, I walk slow laps around the house, hoping the movement will rock my screaming nerves to sleep. Shuteye is fleeting, pale light signals work, and I am just so tired.

Mind Fog 103

Where did I put my keys? I forgot to sign my son's homework sheet. Did I turn off the oven? Long-term pain clogs the brain and causes mental fatigue. The parietal lobe keeps getting sensory signals that something is wrong, the limbic system is alerted and emotional pain multiplies, and the cerebral cortex is under a constant barrage of information. Thus, even without the lack of sleep, the brain is pelted with too many messages. Add in the decreased sleep and you have a recipe for severely decreased cognitive function.

Desperation 104

Pain changes you. I yelled at my kids again. They were goofing off, not brushing their teeth like I asked, playing as brothers should. The monster created by pain and fatigue lashed out. "Brush your teeth and get to bed!"

At first, pain is just that – painful. Over time, the pain remains, but also starts creating other emotions. Frustration: These lightning strikes in my arm are so annoying. Why can't I just lift up the milk carton? Anger: This isn't fair; I eat well, I exercise ... this isn't supposed to happen to me. I treat people with these problems, I am not supposed to have them! Depression: My wife has to carry in the groceries for me. I can't even play with my kids. I feel useless.

Applications for Practice

1. We can't objectify pain. When we ask a patient to rate their pain, and they give us a description and/or a number, it doesn't come close to describing their experience. We will never truly know how our patients feel, and in reality, we don't want to.

There are people out there in tremendous pain every single day. As chiropractors, we need to find the nerve interference and remove it, but we have another job. We need to care enough to realize that their reality is much more than the number they give or the verb they use.

2. "There is no process that does not require time." Principle 6 in The Chiropractic Textbook by R.W. Stephenson DC, PhC, 1927. We tell our patients their condition will take time to heal; an unalterable fact. But on the flip-side: respect your patients' time. We cannot control the clock, but we must do our part so healing can begin.

When a patient is noncompliant and quits too soon, maybe they just couldn't handle the time it was going to take. For others, driving may worsen their condition, yet they travel, sometimes an hour or more, for treatment. Those patients know how vital the adjustment is to their well-being. Patients put time and effort into healing; be grateful every time your hands have the opportunity to serve. Make the time they spent time worth it.

We don't need to take more time with each patient, but we need to ensure that the time spent is with each patient – providing focused, loving, effective care. Never let a patient put more effort into receiving the adjustment than you do into administering it.

3. Precision matters. When it hurts to lie on the adjustment table or when hurts to be touched, we must be spot-on in our assessment and delivery. Whatever our technique, execute each adjustment in a precise manner, using only the force necessary. The adjustment needs to be taken seriously. We can have fun in our offices, but when the patient is on the table and we are going to adjust them, we need to deliver the goods.

4. When a patient is in pain, hope is essential. Many people have been eviscerated through illness and been told there is no hope. The danger is that some become their diagnosis. Healing takes time, but during this time, we must ensure we are instilling hope.

A patient will not heal unless they believe they can. We need to give our patients courage to know they can and will heal. We need to help them realize they can live well in this culture of sickness. As chiropractors, we have the unique ability and responsibility to pull people up out of their diagnosis, to give them hope.

5. They deserve all our strength. We all will experience pain, physical and emotional, throughout our careers. Through these pains, we need to realize we have a calling. We need to muster up the strength to persevere, to leave our pains outside so we may serve our patients to the best of our ability. We need to take care of ourselves, but during office hours, it is all about the patient.

We can change the world. Pain truly is a great teacher. Let's just make sure we learn the lessons.

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