Posted by:
Nightingale
(
)
Date: June 12, 2018 09:50PM
Patients, their symptoms, and underlying pain generators/causes of their medical problems, are not all identical with predictable results.
It can be a process to find out what works for each individual. A procedure, pill or treatment may not work for some patients but that doesn't mean other people shouldn't try it.
The best approach to treatment I have seen is (1) have a single primary care MD who sees the entire big picture and tracks all incoming info from lab, specialists, any source; (2) get referrals to whichever specialist practitioner deals with the body area or organ or system that is causing a problem; (3) have all appropriate investigations; (4) discuss with each practitioner their part of the assessment, and with the primary caregiver all conclusions, suggestions, and advice on how best to proceed. (5) try out the recommendations, in logical order (usually for worst pain/symptoms first) and keep track of results.
Example: For back pain, many patients receive injections for pain (into nerve roots, for example, if indicated) - could be with steroid, anesthetic, saline, other meds. Depending on what is causing the pain, some solutions or approaches may help and some help a little, some may not help at all. A patient is asked to keep track of results, in attempts to assess success of treatment; whatever helps may be repeated (at appropriate intervals), if a particular type of injections is no help, could be tried again or else abandoned or the location of the treatment could be re-targeted (it is not always obvious which level of the spine, for instance, may be generating the pain). Any treatment such as this is usually considered to be of temporary benefit only (as it wears off and then the pain may return but may then be of less intensity). Drs will likely adjust their injectables and levels/locations in the spine or elsewhere depending on results. It may help for a few days or several months or may not be of any benefit but then something else could be tried.
Often, more than one treatment is tried concurrently, such as physio, massage, kinesiology, plus the injections. Again, the success of each treatment, and of the allied health measures employed at the same time, is assessed and one or more treatments may be continued or abandoned, depending on results.
It's all an ongoing process of examination, diagnosis, treatments and assessment of results.
Again, it is different for every patient, depending on many factors.
It is also well established that "psychosocial" factors can affect the perceived intensity of pain. If any exist many MDs will recommend that they be addressed at the same time, if not before, some of the other measures so nobody's spinning their wheels, giving only physical treatment of limited benefit without addressing any and all causes of pain and how it is being perceived (i.e. this varies between individuals and can be affected by many more factors than solely physical ones - such as overusing or under-utilizing certain muscles). Too, it seems counter-intuitive perhaps but often the advice is to work through the pain, such as exercising (if only gentle walking) even though something is hurting. It is common to try and protect a body part that is hurting but often exactly the opposite is better and can promote faster healing (i.e. if someone has a sore shoulder so they don't move it, it can turn into a worse problem - "frozen shoulder", which is much more painful and disabling than the original injury or pain was).
Obviously, someone with complex multiple medical issues needs to be under continuing frequent medical supervision. The best plan usually is to take a comprehensive approach, trying physical and psychological issues at the same time (as prioritized by the primary caregiver after considering all the facts).
A patient can actively participate in their own health and recovery by thoroughly discussing their condition with each caregiver as well as allied health (physios, etc) and also by being diligent in following recommendations (such as exercising regularly and setting goals to increase activity on an ongoing basis).
Both the mind and the body need to heal together in complex cases as either one untreated can hold back progress in the other sphere. You could go to the gym every day but not attend the psych appointments. Can be counterproductive as the best plan and goal is for all aspects of one's well-being to be considered and addressed. Obviously, it takes time and dedication and a lot of effort on the part of everyone but especially on the patient's side.
I am not an expert by any means. These are just my observations from working with many physicians and observing the types of problems that afflict patients and hold them back if they don't find ways to help themselves improve, as well as informing themselves about possible medical approaches and working with the drs to employ whichever ones are recommended for them.
Life goes on, as they say, and there are term limits on it, of course. That's why it's good if a person can carry on living even though they have health challenges. Trying to avoid the (understandable) impulse to put life on hold until physical/psych issues are resolved. Hate to say but that goal of reaching absolute healing may not be realistic. I understand a person wanting to feel/be better before they move forward with other life goals and ambitions but if possible it's better to work on the healing part as well as other things in life at the same time.
I know it isn't easy. It's just that the way a person approaches their situation, their attitude and experience, the advice they receive from appropriate skilled caregivers all go together towards the ultimate goals of at least improvement, if not recovery.
One of my family members has been very ill for a long time now. I have gradually adjusted my initial expectations for a quick return to 100% health down to measuring tiny evidences of any improvement and accepting that as a victory, even though much smaller and slower than I would like.
So, again, attitude plays into it a lot. I could feel gloomy that my big ask of total restoration isn't happening or I could remind myself that any move forward is a positive sign and one to be celebrated. It's not easy to be chirpy some days but I try. And it really makes a difference. Remembering what rock bottom is and measuring from that place upwards really can help to achieve a more positive frame of mind. That is a big step forward no matter what one is struggling with.
Plus, I get sick of hearing myself grumble. Need to change the channel often. A lot of energy that could go towards positive thinking can get wasted by complaining, I have found.
Re the specific topic you raised, BAA, of the spinal cord stimulator: Obviously, something best answered by the appropriate health care provider in that specialty. Generally, the basic approach is to go with the least invasive treatment first and work up from there (so one tries an Rx first, not leaping immediately to surgery, for example). And remember that one patient's experience is not a true indicator of what another's results will be. It doesn't hurt to seek out appropriate, trustworthy resources to reliably inform oneself about diagnoses and potential treatment, all while working with the physicians as well. A team effort. Be an informed patient and an active participant in your own care (if your MDs are up for that). You can be an integral part of your own recovery.