Factors that make patients feel supported and generate their confidence in the doctor include:
• showing an interest in all aspects
• examining the problematic area
• performing a more thorough examination
• picking up 'cues' and drawing attention to them
It is noteworthy just how impressed some patients are when they are physically examined. It is appreciated particularly by those who say: 'The other doctor did not get me to take off my clothes nor examine me'.
Support includes acting as the patient's advocate during the complex process of coping with the red tape of workers' compensation formalities, examinations by other doctors and any medicolegal issues.
Reassurance should be given from an appropriate knowledge base. It should be emphasised to the patient that on the law of averages the chronic back pain should eventually resolve and the patient can look forward to resuming a relatively normal life.
The patient should also be reassured that he does not have malignancy or a physically crippling disorder.
Explanation, basic counselling and patient education
One of the most important features of management is careful and appropriate explanation including the reasons for the pain and why it is self-perpetuating. Click here for further reference to a useful approach, whereby the explanation is that the main triggering factor (the prolapsed disc) has basically resolved but the central nervous system is still registering the pain, analogous to a 'phantom limb'. The development of anxiety and depression has caused continuing overactivity of the pain pathways, which need to be 'switched off' by the various treatments that will be given.
Explore various concerns including the effect of his illness on his family relationships and sexual activity, and provide counselling as necessary. The patient should then be handed suitable patient education material as presented in Figure 10.3 and encouraged to undertake an exercise program ( Fig 10.2 ). Education about the problems of anxiety, depression and lifestyle factors should also be addressed.
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