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Howard, Would you be able to send that video my way as well? Also any other resources for patient demonstrations? I’ve always found any post-grad ed that has live patient demonstrations to be the most beneficial.
Yes, that helps! Following up on the NCD provocative testing recommendation, how often do you find those test being positive? I have done these only a few times which were negative each time, I know they don’t need to be positive for an NCD to be present. After reading the articles shared with us about threat conditioning, I figure I should choose aggravating activities that have been more conditioned than general movements that cause pain as these are probably less conditioned, which would make sense and the app discusses the importance of doing that.
I have gone through the App modules probably 3-4 times and have something new to take away each time, especially with the communication pearls. I was wondering if anyone has some good communication pearls for the following patient scenarios.
1. I have a subset of patients who tend to express some emotions about their pain experience and life stressors related to the onset of those symptoms, but immediately follow it up with a justification for why they shouldn’t feel that way or will same something along the lines of “but I am blessed for…”. This seems to cause a barrier to the healing process. If it helps here is an example, I have a patient whose driver of symptoms seems to be mostly related to repressed anger she has towards her children. As we dive into that she will start to talk about how rough the pregnancy and birthing experiences were and say something along the lines of “they really destroyed me” and talk about how she can’t do the things she wanted to achieve, but immediately back peddle from that and talk about how blessed she is to have them, etc… Throughout the rest of the PRT process she is all in on and has had modest improvement in symptoms but I think this wall we are facing is inhibiting further progress. The lesson discussing the need for autonomy and how internal conflict can trigger danger alarms seemed to fit perfectly for this. Any recommendations on angles to approach these discussions from or insights from similar experiences?
2. This doesn’t happen often but on occasion, I will have a new patient who is very attached to the diagnosis or self-diagnosis that they have like fibro or EDS. I am always very cognisant of making sure my patients feel heard and validated, but when these scenarios arise it seems that my explanations of how pain works (just like how the PRT process explains it) and what the potential to get better is, I would say this information gets refuted would be the best way to put it (i.e., that can’t work for me, there is no cure for fibro, everyone with EDS lives in chronic pain, etc…). I totally understand why those perceptions are there and I explain that obviously, which has helped a few times create some buy-in on the process and allowed for the continuation of care, other times it seems no amount of evidence would be sufficient. In those times I chalk it up as they are not ready for treatment, still in the pre-contemplation phase essentially. Does anyone have good insights from their experiences on this? I am also a chiropractor so a lot of times people come to see me with different expectations than what I actually do so it can be a bit of a curveball, so this might be a unique source of this friction.
I look forward to the feedback and insights from some of you more experienced clinicians/therapists!
Here is a link to one of the videos I like to use to demonstrate predictive coding in person. https://youtube.com/shorts/65p1sA-Cb1E?feature=share