Treatment or Management - Words Matter
This is the great unspoken miscommunication that occurs between patient and therapist. The patient is looking to have a problem “Treated”, the therapist (the good ones at least) would prefer to manage the problem. Why does this small difference in the choice of word need an article dedicated to it? Let’s see.
Issue 1: What is pain?
Let’s start with the big one and try to cover it in as few paragraphs as possible.
Pain is an illusion 100% of the time. Pain itself does not come from tissues. Tissues merely communicate a message and the brain decides if that information is threatening or not. If it is, then a sensation is produced in a location. If the information came from a defined source the pain sensation will be very localised, if it came from a wider or confused set of sources then the pain would be wider spread, or even move around.
Because pain is fundamentally an illusion caused by the brain to keep us safe, it is almost impossible to treat decisively. We can attempt techniques than may change the perception of that original information but we can’t guarantee the brain will do as we ask and remove pain.
Issue 2: Better, Same or Worse?
Surgeons can operate on a site of pain and “fix” what they find. You may know someone who has had an operation and feels better but you may just as easily know someone who had no improvement or even got worse.
It is the same for therapy. If a therapist decides to audit their client records and be honest about the results, they'll likely get a shock! Some clients would have become better, some remained about the same and some unfortunately got a little worse. It’s a frightening thing to do as a therapist. Believe me, I do it regularly.
I teach a lot of people to become Sports Massage Therapists and most of them have an unrealistic ideal in mind. They use the word “fix” all the time. “I fixed this” “I fixed that” they'll tell me when talking through their practice hours. I try my best to break this habit early on in their journey to qualified therapist because they will have a melt down one day when they realise “Fixing” someone is about 50/50 odds. The older, more experienced and far less ego driven therapist, of whom I’m lucky to have met many, know these odds and set client expectations accordingly
(as a side note, the odds are actually pretty good: At least 50% tend to get better, about 20% have no improvement, 25% quit the process too soon before we can make headway [more on that in a minute] and fewer than 5% might get worse for a short while).
Because nobody can guarantee a result, we can’t take the view that we can 'treat' a symptom, pain or discomfort. We can only take a view on managing them and progressively making positive change over time.
Issue 3: But my friend saw this guy who fixed him in one session!
I get this a lot! In fact, on many occasions I’ve been the guy who “fixed’ him in one session. Unfortunately, that doesn’t mean I can do the same for you.
Pain that resolves so quickly and easily is almost always due to placebo. Because pain is an illusion 100% of the time, and is based on the brain’s sensitivity to threat, if a person feels they have done the right thing to “fix” the problem the brain can switch off the pain sensation in an instant. Unfortunately it is impossible to repeat this phenomena with any consistency. If it were, pain would not be the epidemic that it is.
You should take the recommendation for treatment that your friend gave you though. They obviously had a good experience and I have faith that the therapist is very likely to be of excellent quality. So you should give them a shot. Just give them enough time to help you also, not just one go at it like your mate.
Issue 4: The word “Treatment”
The word “Treatment” suggests something will be done to you with some level of expectation of a result. That’s fine if we are doing a general massage. The aim here would be to give a good massage and the benefits of massage are certainly likely occur; like relaxation, mood enhancement, time and space for rest etc. But it is less fine when we are talking about resolution of pain.
We already know that we can’t expect any predefined result. We can even get a negative result. So you are unlikely going to feel “well treated” if the outcome of the session doesn’t go in your favour.
That’s why I prefer to use the word “Management”. Managers deal with the ups and downs, the good and the bad and try to balance things out for a positive outcome over the longer-term. Some days everything goes our way, other days it all goes terribly wrong but thats okay because we are managing the situation.
Why it’s okay to have some bad results
Managing pain is much like the card game, Pairs. All the cards are face down and you get to flip two at a time to see if they match. Over the course of the game you learn where the cards are. So in the beginning it’s all a bit random and by the end you are confidently taking charge of the game (if you paid attention!).
Managing pain is like this because in the beginning I know very little about you. You’re a spread out and face down deck of cards on the table to me. In the first few sessions it is highly likely we won’t make a lot of progress on your symptoms. We are essentially flipping cards and mapping things out in our minds. Seeing what helps and what doesn't.
After a few sessions we should start to see some progress. Sometimes that progress is fast, other times slow and other times somewhat backwards. The Management philosophy allows us to take a step back and ask “Are we trending over time towards a positive outcome with our work or not?” We can’t look at any one individual session and base our success on that.
A bad day is a great day
I probably shouldn't have left this one until near the end but, hey, some of my articles flow better than others too!
Bad days in my world are days when a client reports getting a negative outcome rather than a positive one. Some days I'll get two or three in a row like that for a really bad day. Nobody likes to make people feel worse. However, you need to be aware of a simple fact - There are no good days or bad days in pain management, just learning.
If your symptoms improve as a result of our work together then great, we learnt what works for you and can continue that same train of thought. If your symptoms remain the same, change or get worse then we learnt something too. We need to adjust our strategy somehow. It's like flipping over a card that doesn't pair, we may have lost the round but we learnt where another card is so we can pair it up later and solve the puzzle.
Treating you to a conclusion
The important thing to take from this article is that you should view pain therapy as Pain Management rather than treatment. Allow our combined knowledge of your body (my understanding of pain physiology and your understanding of your own body) to guide us as we search our way towards making a positive change for you. We may need time to ride through the ups and downs together, learning a little more every time we meet.
If you take the more passive "Treat me" approach, you will likely (remember the 50/50 rule) be disappointed in the short term results.
With this approach it is possible to get results that you may not achieve otherwise, especially if your pain is persistent and you commit to the process of investigation.