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Raising the Bar in Rehab


Published February 25, 2010 3:55 PM by
Some of our computer-based documentation program changed this week at work, which included a new section of documentation called "Pain".  While most therapists included a patient's complaints or denial of pain somewhere within their notes previously, this new section is completely dedicated to the description, factors and treatment regarding pain. 

Obviously our field of work involves pain - we are the experts in helping patients move better and feel better.  Thousands of therapists work each day in determining causes of pain, exacerbating and reliving factors and in maintaining a pain-free lifestyle.   Patients with chronic pain syndrome, fibromyalgia and countless other diagnoses are plagued with pain to the extent that it changes the way they live their lives, altering their schedules and limiting work and personal activities. 

Having this new "pain box" makes me realize how much effort and focus physical therapists, as well as countless other health care providers, focus on pain.  It even has its own box!   There are some patients who will deny obvious surgical pain until they are practically in tears, while other patients describe 10/10 pain for seemingly minor strains.  It can be difficult to determine the true degree of pain until you have established a good rapport with the patient or have become a good judge of consistent behaviors.  It is such a subjective measure.

For the purposes of my physical therapy practice, pain is just one of countless factors I consider with my patients.  I consider range of motion and functional strength to be equally as important.  However, these things are also dependent on the setting of practice.  In an outpatient setting, it is generally assumed that a patient will have full ROM and strength and have only one or two deficits- including pain, which need attention.  In an acute care setting, the focus of pain may take a back seat to ambulation, transfers and stairs- as these are the factors more directly related to discharge planning. 

What do you think?  Do you place a heavy emphasis on pain, or do your treatment plans focus on other factors?  Is it right to start a conversation with, "Are you having any pain?" - Therefore drawing more attention to the pain? 


I think we should always ask patient's about their pain, but I do agree this does draw attention to it, where if we didn't ask so much about it, the patient's might not focus on it as much as well.

I'm still a student and I am so afraid of increasing a patient's pain.  I've had more than one patient tease me about this and jokingly scream when I touch them.  

I think it is important that we acknowledge pain and monitor it and do everything in our scope of practice to reduce and avoid it.

Bridget Regan March 1, 2010 8:56 PM

Not long ago the WHO did studies about pain, its perception, and whether or not it was being dealt with appropriately. They found that indeed, it was of primary importance, but yet was treated poorly by most health care practitioners worldwide.

Pain should be a part of any comprehensive assessment. It can impair gait, balance, function, cognition, motivation and more. I have a friend who is currently undergoing treatment for tongue and throat cancer. It has taken over 18 months and numerous operations that resulted in the removal of his tongue and larynx but finally, and most important to him, his pain is gone.

How much more could our patients accomplish if they didn't have pain or had a more manageable level of pain?

Dean Metz February 25, 2010 5:40 PM

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