mixed pain syndromes

[khughes]

hello
I am wanting some specifics about how to manage people with history of degenerative joints/aging related issues who also have many mind-body symptoms/diagnoses. An example would be 70 year old female with moderate OA/shoulder tendinopathy who is pursuing surgery/injections but is exhibiting a lot of “pain catastrophizing”. Wondering about focusing on neuroscience pain education and specific techniques to work with the catastrophizing? Or do you recommend against teaching these techniques if there is a mixed picture (some structural and some mind body).? It seems logical that since all pain/symptoms are predicted in the brain, that many of the same techniques/skills would be helpful even if there is ongoing degeneration in a joint. Would love to hear your thoughts/experience.. Warmly Karin

[abatson]

I think it is important to first consider if this assumption of a “mixed picture” is accurate. We know the body heals – muscles, tendons, ligaments, bones, etc. heal in a finite period of time – short of some sort of environment where it is not allowed to heal, like a broken bone that is not aligned and keeps moving around or a tissue wound in someone with diabetes. If the pain has been present for >3-4 months, why has it not healed? or is it mind-body? Secondly, it is important to pull back and see the big picture – is the particular symptom occurring in someone with multiple other pains at the same time, or a history of mind-body conditions over time, with risk factors, etc.? If it is, then maybe colluding in this assumption of a mixed picture is not what your role should be in the patient’s care – maybe you should be questioning the validity of the diagnosis or at least, really focusing on the component that is mind-body. Third, have you looked at the xrays (I’m sorry – I don’t know your profession, so this may not apply). Do you know they have a tendinopathy or was this just what someone told the patient who told you. What is the evidence for the structural diagnosis? Also, if they truly have a tendinopathy which can be painful (I think), is it really catastrophizing? or is it just painful? Lastly, anyone who has a structural painful condition for more than 3 months, will likely have a mind-body condition on top of it all – this is just how the human brain works – few people can not be afraid or avoidant of pain for that long without activating fear circuits in the brain. To the degree that their symptoms are driven by conscious or subconscicous fear circuits, the neuroscience education and specific techniques can be helpful.

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