I had just met her but my elbow was now firmly planted in the avid tennis player’s left glute. Moments before I had put together her constellation of signs and symptoms and concluded that her sciatic wasn’t getting along with her piriformis. They were involved in a wrestling match, the outcome of which her sciatic didn’t much like. My patient certainly wasn’t liking me either. At the moment I was no longer her PT. I was her pain in the butt.
But instead of karate chopping me, my patient, just like countless others, submitted to the temporary pain of treatment because she believed it would ultimately lead to relief. In her case, it did. Her sciatic symptoms resolved almost immediately. Yet, to submit to the pain, she had to trust me. She also had to trust that pain isn’t always a sign that one needs to “cease and desist.”
I too learned this, though not in school. When my wife and I were expecting our first baby we went to a birth preparation class to learn breathing techniques, pain control and weird massages that my wife was always too petulant during labor to care for.
What we remembered most vividly, though, was an acronym for pain. Appropriately, it was P.A.I.N. It stood for Purposeful, Anticipated, Intermittent and Normal. I’ve since borrowed said acronym and applied it to my patients with analgesic effect.
The P, again, stands for purposeful. This could also stand for “preface” as in a preface to what the treatment is supposed to do. It’s amazing how many doctors and healthcare professionals forget to tell their patients the “why” and then wonder why patients complain or don’t cooperate. It’s even more important to explain to patients that something will hurt, when in fact, it does.
A is for anticipated. When patients know to anticipate pain, they’re less likely to jump off tables, jerk, and/or “accidentally” punch you in the face. Anticipation also helps to dampen the sensation of pain. Creating the anticipation is simple: “this will hurt but I’ll let you know when and exactly what I’m doing. Just breathe with it and let me know if it’s too much and I’ll back off.”
“I” or intermittent, conveys the message of a temporary or fleeting discomfort. “This will hurt but it will go away as I ease off…okay, I’m stopping now. Breathe. Now, we’ll try again, just for 10 seconds. Then we’ll rest again and relax.” Your patients will thank you for letting them know they haven’t fallen into the 7th circle of hell and will stay there for an hour.
Finally, some patients don’t know if it’s normal to feel pain during a piriformis release or a week after a grade III sprain of the ATFL. We might assume they know what we know. But how would they know unless we tell them?
We come across so much pain; we’re no longer as sensitized to it. Yet for every patient, the experience of pain is fresh, undeniable and often scary. Treating them with the P.A.I.N. principles in mind quells their anxiety, minimizes their guarding behavior, and elicits greater participation. It also saves you some “accidental” punches to the face.