Lower back problems are very common and pose a significant problem because pain can be experienced in one situation and not another. Many people in their 40’s and older have desiccation of the intervertebral discs, disc bulging and even small annular tears in the disc. Research clearly demonstrates that the level of degeneration is not related to the pain experience because there are individuals with relatively severe degenerative conditions affecting their spine but who report no pain and who continue to have the ability to perform a wide range of movements and activities without restriction.
This results in a higher proportion of patients suffering back pain being told that there is nothing wrong with them, that it is “in their head” and feeling that they are effectively being accused of putting it all on. In any counselling situation it becomes especially important to avoid being drawn into this kind of conflict situation. It is important to combine a counselling approach that focuses on distraction from pain, reducing pain focus and movement fear with an approach that seeks to improve quality of life. Activity is very important and this means they need to learn how to pace themselves and create a balanced life. An understanding of the pain process and some work to reduce frustration and irritability while encouraging an increase in social and other activities is often important. It is crucial to combine this approach with good physiotherapy that can strengthen the paraspinals, the multifidus and abdominal muscles.
Our clinicians develop a program that incorporates a balance between the physical and the psycho-physiological. Many patients are initially uncertain about how a psycho-physiological approach can prove helpful arguing that the pain is in their body and not in their head.
Head Injury & Paralysis
The key practical challenges here for any patient with a head injury include mood swings, chronic fatigue and memory problems. On a slightly deeper level, a core fear for many people is the fear of “losing” their mind because of the head injury. This is complicated enormously if additional damage is done to the sensory motor cortex resulting in mobility, or sensory difficulties. Ironically, the danger here is of doing too much for the patient. There are situations in which reliance on memory aids such as notes can be continued too long and the patient becomes dependent on them rather than working to improve their memory skills. This emphasises the importance of working with other professionals who can assist with a thorough evaluation of the patient’s potential for recovery. A range of concentration exercises combined with ‘mindfulness’ approaches can be used as well as learning associational strategies to help improve memory.
A parallel danger is when the patient is encouraged to lead as normal a life as possible but does not have it explained to them that normal life may have definite restrictions. One case at our clinic involved a person who was very depressed following an accident that left them with brain damage and paralysis requiring them to be in a wheelchair. Contrary to expectations the depression was more due to “burnout” from the patient trying too hard to return to their normal life. The depression lifted when the patient’s situation was carefully examined and they were encouraged to return to a normal life but to attempt only 60% of their old day instead of trying to achieve as much as possible and becoming caught in a cycle of failure and self blame. They could then work up to 80% of their old life by use of careful pacing and needed to work on developing a number of different work related skills that included better delegation and planning skills.
Our clinicians work using a comprehensive and preferably multidisciplinary approach to assist the patient deal with some of the more difficult symptoms associated with brain injury or severe damage to the central nervous system and spinal cord. This includes a program that aims to target some of the more difficult problems of adapting to restricted function, including:
- Low mood and intense frustration.
- Mood swings/irritability, where this is an issue.
- On-going difficulties with headaches
- Problems with memory
- Difficulty with concentration
We can design a series of interventions tailored to the person’s current needs that can help to extend their coping skills and regain some of their general abilities by a variety of graded mental exercises. We also utilise methods of mood management to help the person develop strategies to calm themselves and reduce the impact of mood swings on their daily life.
When a person experiences ongoing difficulties with headaches, a stiff neck, jaw pain and blurred vision following an accident they do not always consider whiplash as a possibility. Our clinicians can seek to provide some help following a thorough medical evaluation that may include an MRI scan. In other situations, the patient may be in no doubt that their symptoms are due to whiplash but may not recover despite a number of medical and other interventions.
In these situations our clinicians do a thorough evaluation and seek to develop a program that will help the patient in conjunction with ongoing treatment from other related professionals such as physiotherapists who have special interest in working with this condition.
We believe that a helpful set of interventions for this condition include:
- Assistance to improve posture and muscle use in the affected site. This can involve asking the patient to trial some carefully designed stretches that do not require the neck to be moved forcibly.
- A number of established pain reduction and pain coping strategies that have proven helpful with other conditions such as headaches are also used.
The patient is shown how to improve the quality of their life despite the presence of pain.
Burns can result in particular patterns of pain and changes in body self image for years after the experience. Some burns victims experience some symptoms of post-traumatic stress due to the cause of the burns and can also become very socially isolated or self conscious.
Our clinicians will seek to formulate a program with the patient designed to maximise the best possible outcomes.
A useful New Zealand web link is the burns support group in Waikato: