Treating the rellies

I had dinner with a distant relation last week. She moaned about how she could no longer play tennis because she said, “I have two bulging discs and the sciatic nerve is really jammed in between them…. it doesn’t hurt all the time but when it does it is really bad – the doctor says I must not play tennis again.” I groaned internally as I pushed my roast lamb and peas around in the gravy. The story is familiar of course, but a relly*… it really worth going there and do our standard treatments “work” with friends and rellies? I don’t think so.

* relly is a usually fond term for a relation

Notable failures of relly/friend treatment
All clinicians have surely treated their relations and friends in the past despite the mantra “never treat friends or family”. I have heard of some great disasters. I do recall a colleague of mine who manipulated the neck of his accountant wife and set off what appeared to be a nasty long lasting nerve problem, eventually requiring surgery. I hate treating my wife and have left her back and leg pain as ‘hipkneeankleattca‘ (the diagnosis satisfied her for a few years until Google emerged!). I must admit that the greatest failure of reading ‘Explain Pain‘ was my brother with his chronic post traumatic neck pain…. “I read it twice Dave but my chronic pain is different to the ones you talk about, this has got nothing to do with me.”

Other features of relly/friend treatment
There is another side to this story. A third year physiotherapy student approached me once and said, “my granny got bitten on the big toe by a large ant 6 months ago and she keeps saying that it still hurts and could I come and check it out….could the pain from an antbite last that long?” Highly unlikely but the pain of not seeing your blossoming grand daughter may last longer. And a colleague of mine, a very evidence based physio, will travel some distance to ultrasound his mother’s shoulder. What is it all about? What are these stories telling us?

Is there a message in all of this?
Dentists can fill, surgeons can cut and GPs can give scripts to friends and family and there is no evidence that it is detrimental (although some professional associations have warnings of potential dangers such as avoiding necessary questioning and shortcuts). For physios, OTs, chiropractors, psychologists, massage therapists etc, there is nothing to stop you treating friends and rellies except that it just doesn’t seem to work as well. Why is this?

I think it is because the problems that the professions involved in rehabilitation deal with are more related what people think and do about a problem or perceived problem than the actual problem. The dentist doesn’t really care about what you think about the hole in your tooth, the surgeon about your thoughts on the nature of appendicitis – for them it’s find it and fix it and there are clear, often sole mechanical or biological targets. But in the world of chronic problems it’s different. Simply we usually don’t really want to go to the depths of the problem with our friends and relations.

Also, does having to pay money for a treatment make it work better? Does having it for free mean that it’s somehow taken for granted?

And my relations?
I no longer bother. Other than listening to a story for hints of something really serious and the comment “you should challenge that sentence you have been given” and referring them off to someone who I know will follow a biopsychosocial line of thinking, that’s it.

Your turn
An Explain Pain book and audio book to the person who sends in the best story (sad, humourous, whatever) about treating a relation or friend which reveals something of the therapeutic interaction.

New NOI research
We have two new projects starting using Recognise online – they are collaborative studies involving NOI, the Body in Mind research group at Neuroscience Research Australia, the University of South Australia and The University of Western Sydney.

One project focusses on how the ability to make left-right judgments develops as we do. For this project, we want kids to get onto the computer and have a go. We have used photographs of kids’ hands and we ask a few questions beforehand. One is about pain, so it is fine to do this even if you have a sore hand or arm (in fact, it would be great to see how performance might change in this situation). Depending on the age of the child (we are after 5 – 18 year olds), mum or dad or a responsible adult might have to walk them through it.  It should take less than 20 minutes. Although we are after kids, it might be interesting to see how adults perform when the images show kid’s hands, so we have opened it up to anyone.  The lead researcher on this project is Shikta Dey, who has called it OMIT – On-line Motor Imagery Task.

The second new project is being led by Kathryn Nicholson Perry at the University of Western Sydney. This one is focussed on getting data from people with lower limb problems, in particular those with a spinal cord injury. So, if you know anyone with a spinal cord injury, tell them about this study! Again, there are a few questions to answer and then the tests. It will take about 20 minutes.  Please help us to cover new ground – we look forward to welcoming you to the Cutting Edge.

Legendary instructor of the month
Max Zusman is a (nominally) retired former private practitioner (30yrs) and university lecturer (20yrs) who is now occupied by a busy national and international post-graduate teaching programme. His long standing interest is in pain mechanisms and their realistic management with physical treatments – chiefly movement based. He is one of the profession’s pioneers in this area, and continues to act as an information source and advisor to researchers and colleagues in different parts of the world. He publishes reviews of appropriate topics, as well as original thought-provoking and potentially clinically relevant science based models aimed at informing our clinical reasoning and decision-making skills.

Max instructs The Problem Pain Patient (Der ‘problematische’ Schmerzpatient) with Martina Egan-Moog which is an advanced 3 day course aimed to benefit medical professionals (therapists, doctors and scientists) in their clinical reasoning and decision making processes. He turns 76 on the weekend, and his hobbies are [still] golf, billiards and Barbie. We wish him a wonderful day and are sending over some big hugs so they get to Perth in time.

Zusman M (2009): Ubersicht uber Schmertzmechanismen: Implikationen fur Diagnose und physiotherapeutische Behandlung “problematischer” Schmertzpatienten. Manuelletherapie 13: 167-173.


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