The past week contained quite the battle between myself and a source of anxiety that I have struggled with. In my last video, I mentioned that I am beginning a new outpatient pain rehabilitation plan. Last Thursday, I went in for the assessment for this and left feeling battered, bewildered and a little bullied. It’s taken a few sleeps, but I’ve waded through this confusion for far enough that I am beginning to understand it.
The overwhelming feelings have actually turned out advantageous as I am now aware of exactly what I hope to achieve from participating in further outpatient therapy. It’s always a nice moment of clarity to realise that a seemingly negative experience doesn’t necessarily need to have a negative outcome.
A physical and psychological assessment is a gruelling experience. Having seen so many practitioners since my CRPS began, I have lost a lot of patience for going over the details of my daily life. It’s just one of those things that has to be done; a new practitioner needs to know a patient’s history and get to know their condition and what they require help with.
I try to dissociate from my annoyance at this procedure. I aim to greet each new practitioner with an open mind and not relate new experiences to traumatic ones that I have previously endured.
The assessment involved three consultations; one with an occupational therapist, one with a psychologist and the last with a physiotherapist.
The OT consultation went fine. I was able to chat with the therapist about the things that I can do, what I would like to be able to do and where I feel that I need more help to get a sustainable sense of pacing happening. My solo efforts on this front are consistently thwarted by unforeseeable circumstances and I am always looking for tips to better manage daily living. I was tested on basic functions such as bending, reaching and carrying. It was no surprise to discover that I am a total weakling.
The psychological assessment was a little bit harder to deal with. The activity of the previous appointment had sent my hands and forearms into a burning flare. It can be hard to concentrate during rising pain, however I got through it. I find that the hardest thing with psychological exams is needing to discuss everything in my life that could possibly upset me. It’s all very personal stuff and can be quite confronting to share the intimate details of my life with a stranger. Especially when I know that person is quite literally judging me – not by a moral compass but by psychological evaluation criteria.
Psychology is a topic that fascinated me long before I ever had to deal with CRPS. I enjoy learning more about how and why I am who I am. Even more so, I enjoy learning about how artificially constructed and therefore changeable many personality traits are. I police my thoughts, try to let go anxiety that is purely for anxiety’s sake and keep an eye out for particular thought habits that are increasing my suffering with no benefit.
I think that putting so much time and energy into learning about how to cope with the psychological ramifications of chronic pain has caused me to be hesitant to any sort of treatment that involves somebody else trying to figure out what’s going on in my head. That’s my job.
I recognise that most patients that psychologists see aren’t yet approaching their pain from a self empowered perspective. I am hopeful that now the first awkward consultation is over I can learn from the sessions.
There is always more to learn, always another perspective and nobody who is perfect at coping all the time.
The final part of the outpatient assessment was with the physiotherapist and was the source of most of my follow-up anxiety. Being the third appointment of a long day (for me) it was getting difficult to think clearly. I had a lot of trouble articulating what I wanted from the program, other than to increase my general strength and methods for coping.
During the psych examination, I was asked whether I would prefer group or individual treatment. I expressed that I would prefer individual so that I don’t find myself feeling held back by the idiot (you know, that idiot that is in every group situation, the one that asks a million unnecessary questions and whom everybody else wants to strangle). Since participating in a lot of group activities during my inpatient program in 2009, I have recognised that I learn more and progress more quickly with one on one help.
After having discussed this with the psychologist and watching her nod and understand what I was saying, it was a little confusing to have the physiotherapist almost manipulate me into agreeing to a group program. I was told that individual sessions are generally only for patients who can’t cope with being in a group. That’s fine and all, but why did I need to think about and express why I would prefer individual treatment if that was the bottom line?
This sort of withholding of information, whether intentional or not, is incredibly frustrating. I am yet to come across any sort of hospital treatment in which the practitioners are upfront and honest about what the patient can expect. I think it’s important for doctors and associated practitioners to recognise that even though they deal with the same program week after week, a patient doesn’t immediately know what to expect without proper explanation.
The second point of absolute frustration was being told that I was not to continue to see my Feldenkrais practitioner during the outpatient treatment. For some reason (I expect boringly bureaucratic and more related to receiving outside physio or psych treatment than Feldenkrais in particular), they wanted me to stop the one course of action that reduces my pain without medication whilst upping my exercise routine, which will undoubtedly cause increases in pain until I gain strength. This did not sit well with me at all.
I left the physiotherapist appointment feeling like I was just about to be shoved back into a production line of activities that are designed to help with beginner pain management in general. This was the opposite sort of treatment that I need, which is for the physiotherapist to work in with the Feldenkrais that is already helping me and to cater specifically to improving my function around my pain, for me, in my situation.
I’ve been through the cookie cutter before and I came out crumbled. I have no intention of changing the things that I am already doing, and that are helping me, in order to fit into the box of what doctors hope will help chronic pain patients.
For days after the assessment, I found myself waking confused and very agitated. My mind was circling with anxious thoughts about the program, related upsetting emotions from my previous bad experiences and a general feeling of dread about embarking on what seemed like a useless plan of repetition.
Thanks to forcing myself to confront the anxiety and try to get at its roots, I have been able to get past the mental obstacles that were standing in my way.
The physiotherapist spoke quite a bit about hydrotherapy. I had been feeling some aversion to hydrotherapy in the weeks leading up to this assessment. I was too exhausted to process my thoughts about this during the session and the result was a lingering dread that I would have to participate and that I would fail at continuing hydrotherapy after completing the 8-week program. In the real world, getting to and from the pool and all the associated elements of going in a swimming pool (the heat, changing, showering, hair removal) are hard to tolerate, raise flares and leave me feeling helpless.
This realisation led me to the discovery of what I actually do want to gain from outpatient rehabilitation: to learn more techniques for strengthening my body, managing my pacing and managing the pain without needing to travel to do so. I want an exercise program that I can practise and build on at home. I want guidance so that I don’t get lost in the beginning when pain flares up and plans need altering.
Knowing what I want is the first step to getting just that out of this program.
To ease my anxiety, I contacted the hospital for further information. I was able to speak to the Exercise Physiologist (no, I don’t really know what that means either) that I will consult with during the program. She was able to alleviate my concerns about being trapped in group classes and hydrotherapy. Gaining a clear idea of my goals helped me to accurately express what I needed, I was also able to get a clear idea about how the first session will run and no longer feel like this Thursday will bring several hours of a physically and psychologically exhausting unknown.
I feel stronger in my reasoning for wanting to continue with my Feldenkrais and I feel capable of explaining this to the physiotherapist with whom I’ll actually be working – a different person to the one who assessed me. This is another piece of relieving news on account of I just didn’t gel with the rigidity of that practitioner.
The goal of both pain rehabilitation and Feldenkrais is to give the patient methods for coping with their situation without requiring regular treatment from others. That’s my goal too, however I don’t feel the need to pretend that I will miraculously be able to cope with sudden stoppage of a treatment that lowers my pain, at this stage. I also feel hesitant about taking this advice from people running a program that does not include any Feldenkrais at all, I can’t help feeling like they perhaps don’t really know what I’m talking about.
After sorting through all of this, I am feeling much more positive about the program. I feel much more up to the task of asking for what I need and expressing why and how certain approaches do or don’t work for me.
You could even say that I’m feeling a little excited about beginning another chapter in my journey to recovery.
Love & Thought Filing,