In the moment:
I suspect I will be using variations on this title for quite a few posts in the future as it’s wide-open for quite a few different topics.
On this occasion, I will be talking about a subtle sub-component of daily practice which caught my attention yesterday afternoon, as I was discussing pain and cultural scripts with a patient (British stoicism/stiff upper lip versus Latin sense of drama and pathos) and how these can influence practicing styles, choice of language.
I have also been considering the work by my friend Dave Newell on CARe (Contextually Aided Recovery). The work is much and unfairly maligned by some of the factions within the chiropractic profession, but in my opinion, this is largely due to the fact that the end-conclusion is that it’s less about chiropractic techniques and more about their applications (style vs substance)
In all fairness, the topic is incredibly complex, it should discuss variations across, age groups, male/female, degree of self-awareness, learning/expression styles etc but that’s not the issue I want to discuss today…
What I realised yesterday is that often times people associate pain with weakness.
Think of how quickly, in Britain, pain is equated to weakness. It is part of a cultural script. And whilst, again, it would be fascinating to go into that further and how that this mind-set is a cultural by-product of a hardship mentality, is great at driving entrepreneurial spirit and will singlehandedly be the trait that makes Britain Great again (sarcasm), that is not the issue I want to discuss today either…
What I thought would be interesting is to contemplate how often we look at the site of pain (say knee pain for example) and immediately clinicians will point (and patients will believe) that “the muscles there (or in the glutes-another classic- need strengthening”.
I have literally heard it (many) thousands of times.
And whilst it’s not wrong perse, neither is it right. Or right enough, as any scientist will say nothing is ever absolute, we only ever approximate…
And it pains me to say (although I obviously relish the opportunity): the script is wrong enough for me to say that it needs improving on. Actually needs to. Because money and time are being wasted in vast quantities over the misuse of the old script: Treating the symptom, whilst incredibly charitable, important, and helpful, is regularly only part of the story and unless the other part of the story (when it’s there) is addressed and corrected, the fact is that problems will keep occurring, keep inconveniencing the patient, keep hindering them in achieving their goals, life-style, quality of life and keep costing the health-system vast quantities of money in treatment and expert time. That I object to: wasted human suffering, wasted resources which could be spent on other important things.
Important things like other diseases. Age-related research. Education. Really important stuff to which we don’t yet know the answers.
That recurring, ongoing knee problem I was talking about earlier? If there isn’t a meniscal tear or other injury/pathology: let’s look at the mechanism please. Let’s look at how this person is loading through the knee… and most importantly; let’s look at the why. Structural anomaly? Functional anomaly? A mixture of the both?
Now we’re talking, now we’re getting to something which is relevant, even if it’s not saving lives, it’s saving quality of lives and that may not be the most exciting type of medicine, it is a very important one.
I will refer to this sentiment in following blogs because I believe that it’s all worthwhile, but in essence: shall we stop looking at the pain and focus on the problem?