How Helen Deals with Chronic Pain

Helen is a 44-year-old woman who has been experiencing low back pain for the past 4 years. She first noticed the pain after she lifted a heavy object. Helen didn’t seek help for her pain when it first occurred; it has now become a chronic pain condition. She has had to quit her job.

Helen lives alone in her apartment. She worries about paying her rent and no longer goes out except to keep her medical appointments.

Helen finally seeks help for her chronic pain, and is referred to an orthopedic physical therapist specializing in low back pain.

Helen reports her symptoms as aching and burning in her low back that spread to her right outer thigh. The symptoms are present constantly, even at rest. The pain interferes with all of her activities. It makes her afraid to perform simple tasks like bending and lifting, walking more than a short distance, or even standing for short periods of time. She has difficulty sleeping, and wakes up throughout the night. Her doctors have tried a number of medications to ease her pain without much success.

Helen’s physical therapist performs an evaluation and notes that Helen has poor posture, and weakness in her hip and trunk muscles. Helen is also fearful of moving or of being touched during the exam. Her therapist performs specific tests to rule out any serious underlying condition, and finds none.

Over the course of treatment, Helen’s therapist educates her about how the pain system works, and how the brain and central nervous system can create chronic pain. They discuss ways to help cope with the problem with imagery and relaxation exercises. Helen also learns how inactivity and fearfulness can feed into the pain symptoms. Her therapist encourages her to begin more activity. The therapist shows her better ways to use her body with less stress and strain with daily activity.

Helen begins to participate in more of her normal daily activities. She learns that it is possible if she balances the activity with short rest periods to control her symptoms. As she begins to prepare some meals for herself and to do some light housekeeping, she realizes she can live a fuller life without increasing her back pain. Helen also needs to learn exercises to improve her conditioning. After years of inactivity, she feels tightness and a lack of strength when she tries to be active. Her therapist prescribes exercises specifically to address Helen’s flexibility and strength issues, and her goals to walk, stand, and sleep with less pain. She is given specific exercises to mobilize the nervous system to improve its health and aid it in becoming less sensitive. Helen also performs exercises that help the brain to recognize the involved areas of her body better and become less sensitive to changes. The exercises are gradually increased as Helen’s condition improves.

After achieving her physical therapy goals, Helen can tolerate movement much better, and has lost her fear of being touched. She is sleeping better, and is able to walk with improved posture. She also walks for longer distances without increasing her symptoms, and has resumed going to her local church for Sunday services. Helen plans to continue her exercise and treatment program at home and to get a new job.

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