Breaking through post-op pain – putting patients at cause
I just saw a young girl in the office today who was in for her first post-op visit following surgery performed 3 days ago. She’s a stoic young gal, but I think I could honestly say that this was her first time having elective surgery. Granted, she’s a mother of 2 children, but still, this is the first time that she’s been down and unable to help around the house.
The surgery was an excision of plantar fibromatosis. Inherent in this procedure is that fact that an incision on the bottom (plantar aspect) of the foot requires 3 weeks non-weight bearing. This young gal is on crutches and still trying to be a mom.
In light of these issues, there was still one more issue that I feel rises to the top of my list in managing her care. And that fact was that she was unwilling to move her foot. Her unwillingness was certainly due to her pain, but it was also due to the fact that she was scared. And interestingly, those two issues, pain and anxiety perform a terrible dance with each other. The reason that it’s so important to break-up that dance is that it’s the first step in breaking into the pain cycle. I was taught long ago that each part of the body has a certain rhythm. And pain locks that rhythm, creating more pain.Â
So how do you break through on this kind of pain and regain that rhythm? The first thing is touch. It was important for me to lay hands on this young gal. I begin with light touch. Reassuring touch so that she feels safe. The second key is to try to initiate motion. Simple, slight rhythmic motion. And once the patient is reassured that she can move, I move just a little more. The goal is to try to get the patient doing just a little bit of motion on her own before leaving the office. This particular patient left with instructions to begin range of motion exercises, writing the ABC’s using her ankle as a pivot point. And you know, by the time she left, she was moving pretty well.
Pain is a funny critter. There’s a number of ways to manage pain, but the best way is to build a sense of confidence in the patient. Sure, narcotics are necessary, but it’s also important for patients to gain psychological control of their pain. I try to put our patients at cause rather than being the effect of their pain.
Jeffrey A. Oster, DPM
Dr. Oster cannot answer medical questions or provide medical care through this blog.
Tags: Pain managment, plantar fibormatosis, post-op painfoot and ankle surgery
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