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“It’s Going To Be Okay.”

February 9, 2018 • Pain Science • Kory Zimney

When teaching weekend courses we often refer to this statement as some of the most powerful words in medicine. The ability to deliver reassurance to our patient that things are going to be okay can have a powerful effect on their outcome. As with everything that can have a powerful effect, that effect can be positive or negative depending on how we use it. It is well understood from a neurobiological perspective that when a patient expects to get better that many positive physiological, behavioral, and social responses are involved in assisting in recovery. Belief and hope are powerful treatment tools.

When delivering reassurance the health care provider needs to determine that no significant injuries or illnesses are present. False or inaccurate reassurance leads us to violation of the “First do no harm” principle. We need to do our due diligence to rule in or out any potential serious pathology that can be occurring within the patient in front of us. A sound clinical examination is imperative to help us with this determination. The evaluation of the clinical exam findings need to be synthesized with sound clinical reasoning. While we need to be cautious to make sure there is no sinister pathology, we also need to protect against the other end of the pendulum that we are not creating a “mountain out of a mole hill” with some findings that we can come across within our examination process. Everyone will have deviants from normal; the bigger question we need to consider revolves around is that deviation relevant to this condition or a true predictor of future risk of injury or illness.

The literature on reassurance for our patients is very interesting and would encourage a read of a few articles that this post is synthesized from:Pincus, et al., 2013; Coia and Morely, 1998; Linton, et al., 2008; Sep, et al., 2014.

The use of medical reassurance is complex process of psychological components of patient illness behavior and provider persuasion.

Sep showed in their study that it may be very important to deal first with the patient’s emotions and illness behaviors before providing additional medical information. As a provider, we need to understand the importance of timing and having developed trust through empathy and compassion prior to instilling our medical knowledge and utilizing our persuasion techniques to calm a person’s fears and anxiety down.

Bottom line: Make sure you are mindful of your patient’s emotions regarding their condition. Provide reassurance mostly in the fashion of cognitive reassurance that may increase knowledge and enhance the patient’s self-efficacy and control. Trust in the practitioner may be a key component on how well reassurance is received and whether it increases or decreases fear/anxiety in the patient. Be aware that reassurance is a very delicate process that as a clinician you should not take lightly and pay mindful attention to how the patient is understanding and coping with your reassurance. We should notice improved compliance, better management of symptoms and coping with any relapse of symptoms, acceptance of current condition all leading to improved health and reduced impact of health problems on life if reassurance (and treatment) when done properly.

Remember if a patient comes in because they #choosePT, good clinical treatment does not always have to entail multiple visits.

It is okay to do a sound evaluation, find nothing sinister and send our patients on their way with some reassurance that “it’s going to be okay” and basic guidance to recover.

Kory Zimney

Kory is a physical therapist with 25 years of experience and a dedication to changing how people in pain are treated. Current Roles: Associate Professor, University of South Dakota Faculty, EIM Research: The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature The clinical application of teaching people about pain

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Commented • February 14, 2018

And so, I then see myself sprinting, far away from the cave of uncertainty and swiftly back onto the road of reassurance, the place I feel secure. But one day, along my reliable road of reassurance, I tripped into a sinkhole.


Commented • February 10, 2018

Kory, Excellent post. I often say the expert does the basics extremely well. That means we conduct an efficient, thorough, and detailed history and physical examination followed by sound clinical reasoning to determine that indeed the patient is appropriate for our care. It is only at that point that we can confidently and honestly say, "The good news is that there is nothing serious or life threatening going on, however, you are really hurting and you are in the right place to address that, so lets get started." Tim

Jessie Podolak

Commented • February 9, 2018

Great post, Kory! In his book Aches and Pains, Louis Gifford says, “reassurance is analgesic.” I might have said, “Amen, brother!” outloud when I read that. :-) Like you, he points out we have no business reassuring until we have done a sound exam and ruled out red flags. It’s amazing to see the calm that comes over some of our patients when we are able to say “there is nothing alarming with your exam, and the symptoms you’ve described MAKE SENSE. There is a good explanation for what you’ve been experiencing, and there is a lot we can do the get you to a better place. You’re going to be okay.” Thanks for the great reminder of the connection between first do no harm (false reassurance)!! Jessie

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