Sriracha, the fiery red Asian chili sauce, is the latest condiment craze in America. Besides being found in restaurants and grocery stores, Sriracha has somehow found its way on top of doughnuts and pastries, in ice cream and lip balm and is even touted on T-shirts and various other merchandise. It’s taken the culinary world by storm, and isn’t stopping there. If you search Google, you will find photos of Sriracha bottles captured around the world, as if it were the “traveling Nome”. So what is it with this sauce that makes it so desirable and a part of pop culture?
This got me thinking, what is the “secret sauce” in physical therapy, what every patient really wants to know? The book “Aches and Pains” by the late Louis Gifford, one of the leading pioneers of our profession in pain neuroscience education, provides some valuable pearls of wisdom on the topic of what patients really want. We, along with medicine and our profession, often place an enormous amount of stress on ourselves to “fix the patient” or to produce an impressive result. Further, Gifford points out that as a profession, we struggle to give our patients rational answers to simple questions and make clear what we can and cannot do. Think about it, what information do you expect to receive from the doctor when you have a bad cold? Do our patients really expect us to fix them or do they want the answers to these four simple questions,
• What is wrong with me?
• How long will it take?
• What can I (the patient) do for it?
• What can you (the healthcare provider) do for it?
What is wrong with me?
Most physical therapists, including myself, would probably argue that this is the question that we are are best at delivering. Over the past year, I have made a dramatic shift here, challenging myself to think about this question from our patients’ vantage point. Think about your own patients: why do they come to see you? PAIN, they hurt! So, why then do we educate them with biomedical fallacies instead of education about pain? Think about the last time that you got out the spine model, only to have a segment or two fall off on the floor or what about that knee model with its overstretched ligaments of disintegrating rubber or the chronic dislocating shoulder model; what kind of message is this sending your patient? It surely is not a positive one; instead, it’s likely one that induces increased fear of what is really going on. A 2010 study in Spine by Tim Sloan et. al. examined explanatory and diagnostic labels and perceived prognosis in low back pain. They identified two themes: patients frequently described their pain in mechanical terms, most often using terms of compressive forces. The other theme was pain as a result of progressive loss of structural integrity; “wear and tear”, “getting old”, “spine is crumbling”.1 In other words, our words (intended or not intended) have the ability to both harm and heal.
So, the next time you go to get out the anatomy model, leave it in the closet. Use your skill set and knowledge to educate the patient about their pain, without using biomedical language, and frame it in a way that is simple, and most important, instills hope. If you want to learn more about educating your patients about pain here is my short list of resources:
• Lorimer Moseley – Pain. Is it all in your mind (YouTube)
• Understanding Pain What to do about it in less than five minutes
• Adriaan Louw – Therapeutic Neuroscience Education (Book)
• ISPI – Therapeutic Pain Specialist Certification
How long will it take?
This is likely the most difficult question to answer for our patients, especially for more novice therapists who have a limited mental case rolodex to rely on. There are a lot of variables that go into answering this question which makes providing our patients with exact answers difficult. The truth is that our patients do not need a specific date, they really are looking for a time frame, something to provide hope that they will feel better, and a frame of reference to look forward to. One simple, yet powerful concept that can be tactfully delivered is the notion that tissues heal. Think back to your knowledge of the phases of healing and the time it takes tissues to heal. Use this information to reinforce the idea that their tissues are not broken, or damaged, they are strong and have incredible healing properties. The second message to deliver is that pain and tissue injury are two different things. This is where pain and injury or dysfunction begin to be pulled apart from their entwined web of relation. Pain by its very nature is variable, unpredictable – Its up, its down – and cannot be explained by pathology. Gifford calls this the Toblerone effect after the Swedish chocolate. Again, another great opportunity to educate your patient about pain neuroscience.
What can I (the patient) do for it?
Empower your patients and promote self-care. Declining reimbursement, third-party payers and healthcare reform are driving this movement. But, the silver lining here is that there are countless studies on the benefits of exercise, especially aerobic exercise. As healthcare providers, we need to take an active role in empowering our patients to lead healthier lifestyles. Secondly, if we are able to make the “unknowns, known” for our patients through educating them about their pain, this will help them minimize their contact with additional healthcare providers and avoid additional failed treatments, both of which have been shown to be risk factors for poor outcomes (yellow flags). One phrase that I have adopted in my practice is “the day my patient no longer needs my help, is the day I look forward to most”.
What can you (the healthcare provider) do for it?
This is where you get to tell them all the really cool things we do as physical therapists. First, reduce pain. The number one predictor for chronic pain is acute pain. Secondly, “prime” your patient’s expectations, effectively laying the ground work for what you can and cannot do. Having an understanding of the plan of care will help to reduce any anxieties or fear your patient may have. It also opens the door to discuss goal setting and to learn about what makes your patient get out of bed in the morning. Use this as motivation.
So, for you’re your next evaluation, ask yourself, did I answer the 4 questions, did I give my patient what they really want, the secret sauce?
1. Sloan TJ, Walsh DA. Explanatory and diagnostic labels and perceived prognosis in chronic low back pain. Spine. 2010;35(21):E1120-E1125. doi:10.1097/BRS.0b013e3181e089a9.