From the first meeting with our patient we recognize the trouble… “My shoulder pain first started 7 years ago. My first diagnosis was… Stop playing violin was the solution. I did that but after a while the same pain came back even without playing. Then I went for second opinion. This doctor told me it was… and gave corticosteroid injection. This did not change anything. One year later someone told me doctor X is very good with this…”
Patients with chronic shoulder pain request a radically different approach. Before you start, ask them these questions to change their perception and get them ready for the start:
1. How much does your shoulder pain interfere with your life on a scale from 0 (I can do all I want) to 10 (I can’t do anything that I would like to)?
Suffering from chronic shoulder pain is like living in a house with a defect burglar alarm going off day and night. The pain is always present, sometimes frontstage, when you focus on the pain, and sometimes backstage when the brain is occupied with other priorities. This affects your choices for behaviour in an attempt to dampen the alarm. After a couple of years, your life content is not what it used to be and this is an insiduous process. Scoring this question will sharpen your patients view on how they have adapted.
2. What has avoiding painfull activities brought you?
It is a natural intuition to stop doing what hurts. When you keep doing that for 7 years, you end up still in pain and without all your activities that previously made your life meaningfull like playing music, dancing with friends. It’s important to be aware of this maladaptive coping strategy which is not a successfull one to turn the tide and start increasing your patients activity level again.
3. What if it would stay like this, forever?
Patients in chronic pain search for help but a lot of them are not `really´ ready to start rehabilitation. They have low outcome expectancies and play a passive role in the process. “Help me, cure my pain, find the cause!” This question is a scary one which awakens them from a sleepy search for help. It raises awareness that they will have to take this chance for improvement because there probably will not be a better alternative and living with this pain, forever, is often not an option. There is no other way than this way forward with physical therapy.