Regarding your question about the care of your patient…an “82 yo F with Parkinson’s, depression, cognitive decline, vasculitis, hypertension and hyponatremia, who was referred to me for post-herpetic neuralgia”…
First of all, I think you deserve kudos for so patiently sticking with it and with her. I would think that even though you may not feel you are making progress, her time with you improves her quality of life. It sounds like she has had some great sadnesses and disappointments in life. You are giving her some reprieve from that and reminding her brain and soul that she is worthy of kindness and compassion.
I have found it to be a challenge working with elderly when there is cognitive decline already present. They may tend to forget the information and recovery methods you imparted and even what it felt like to experience compassion or love.
Late stage aging can be so terrifying – the failing body, the humiliations and vulnerabilities, the constant reminders of what you can no longer do or shouldn’t do…and then there is death looming which for some can be the most terrifying.
I think that sometimes while our goals for our chronic pain patients may be no more pain, it may be wiser (and even more compassionate) to just meet them where they are, be with them in the way they want to be and just listen and support. Humor is always a good tool when all else fails.
When my patients are exhibiting a lot of resistance, I interpret that to mean they just aren’t ready for the work and need more time to learn to relax in their bodies, feel calmness and safety, decrease general anxiety.
Hope something in this message helps.