Hi everyone,
I am currently on my Musculoskeletal prac and had a interesting situation in which I wasn’t sure how best to deal with.
A gentleman presented to the clinic with a history of lower back pain and hypomobility of the Lx spine. He had also been diagnosed as having delusional psychosis which is a mental illness characterized by radical change in personality and a distorted or diminished sense of objective reality.
In doing my objective Ax on this gentleman, namely his PPIVM and PAIVM it was very difficult to get a clear idea of his “pain picture” as everything I seemed to touch or do caused him pain. Even with the lightest of touch he was complaining on pain- however, his responses were very inconsistent as I could be doing the testing without asking him a response and he didn’t complain of any pain but as soon as I asked him how something felt he complained of pain. The problem I had was determining what the best treatment was for this gentleman as I didn’t have much of an idea what his main limiting problems were. In the end I went with my main findings however I wasn’t sure exactly how accurate they were such that I felt that my Rx was rather pointless…
Just wondering how other people would deal with a situation in which you can’t get a clear picture of the individuals problem due to the inconsistent pain responses.
Hope everyone enjoys their final 2 weeks on prac!!
Debs
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Hi Debs,
Yes tough situation. During my musculo prac, I had a couple of patients with pschological issues/illnesses and they often gave inconsistent responses to objective testing. What can you do. One solution is to persist in your questioning and use closed questions. Don't give up until you get some definitive answers. Alternatively you can wait to the next treatment session and see how the patient feels and thus you can see if you were on the right track with your original diagnosis. I also noticed that when one of my patients was taking medication for his illness he was more communicable and gave more consistent responses than when he wasn't. So encouragement in this area could be another solution.
Cheers
Nico
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