Outpatient Pain Rehabilitation: Week Two

Dear Audy,

You could say that the title of my last post was misleading. It wasn’t really day one, it was week one. I should mention that the program that I am participating in involves eight weeks of going in to the hospital on one day each week.

The second week of outpatient activities has given me a little more to work with, albeit I did leave on that day feeling a frustrated that I had to sit through more basic education to get to the helpful part.


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The topic of the group education session was “Pain & Cognition”. This is quite an interesting topic once you get past the introductions, however, that’s the thing about these sessions, they aren’t designed to go past the introductions.

This particular session barely went past “here is the handout”. I was the only person who showed up, aside from the teacher, until fifteen minutes into the class time. When one other person showed up, she began introducing the topic to the two of us. When another couple of people showed up five or ten minutes later, we began again.

I’m not particularly bothered by punctuality, we all run late sometimes. What bothered me about this session was that the teacher had no idea who was expected to be attending and was rather flippant about just skipping the class if no one else had shown up.

The lack of organisation infuriated me. I don’t just magically appear at the hospital, I need to be driven there and then my driver needs to go off and entertain themselves for three and a half hours before collecting me again. I don’t think it’s too much to ask that the hospital at know if a class will be going ahead in time to inform those who are traveling to attend.

To sum up the class, we have an immediate memory, short term memory and long term memory and sometimes pain can interfere with these functions. Woah, man.

The more helpful part of the day was the time spent with the exercise physiologist and occupational therapist. I was finally able to get a bit physical and start figuring out what my baseline tolerance for certain activities is.

The approach that this program offers toward pacing is to determine baselines and then begin to strengthen by working from half that amount of time. For example, if I can sit for ten minutes before increasing the pain, then I should only sit for five minutes before changing my posture.

In theory, I really like this approach. In reality, it’s a bloody difficult thing to try and figure out. It’s been almost a week and I’m still not really sure what my baselines are, I’m just sort of going with the flow and trying to move every time I notice a pain increase. I realise that the point of this approach is to move before that, however I guess find the before that is a process that in itself takes some figuring out.

Other things that I have been working on improving include my core strength and my body mechanics. Feldenkrais is progressively heightening my proprioception and I am becoming more aware of when my body is moving efficiently and when it isn’t. Working from both this angle and the “correct ways to do things” offered by the occupational therapist, I hope to reach some sort of happy, keeps me moving forward, level of function.

I’m not so sure that there is a correct way of doing things, you see, so I’m not about to go get all rigid about posture when I have had far more success using Feldenkrais principles. I do, however, need to increase my general fitness and strength and there are definitely ways of doing this that are less harmful than others. It’s for this reason that it helps to work with someone who is trained in the more rigid approach to body mechanics.

Working with the exercise physiologist helped me to recognise some small ways that I am still moving that are lopsided. I had no idea that I was still limping through my left leg to protect my hip when I climb stairs. It’s only a tiny amount, however tiny amounts of things can have huge consequences in a sensitised body. Awareness of this habit means that I can be on the watch for imbalance and attempt to get walking happening evenly again.

I haven’t been particularly successfully at getting this baselines thing happening, however I have been very successful this week at managing my pain effectively. I have been increasing the amount of housework that I can get done, doing more driving, riding my exercise bike, stepping up my discipline at turning to Feldenkrais as soon as the pain starts to rise and just taking all round better care of myself. I definitely feel like I’m winning.

I’m am back off for the third day of outpatient therapy this week. I have decided to skip the frustrating group session part and just show up for the active part. I don’t need that negative element getting in the way of learning from the positive ones. I tried to let them know that I did not want to attend any more of the sessions, however, of course, there was no one to let know, no one co-ordinator.

I really don’t know if they are expecting me or not, it’s been a bit like bashing my head against a wall trying to get an answer to “does your bureaucracy state that I need to attend the education sessions in order to participate in occupational therapy and physiotherapy?”. I’m just going to go with “no, it doesn’t” and see if anybody notices.

Alrighty then, I’d better give this baseline figuring out thing another go. I’ve been sitting in this particular position for about half an hour. The pain is only ever so slightly increased. Does that count? The increase pretty much happened when I sat down, but then stabilised. DOES THAT COUNT? Oh, ugh. It’s confusing, it is.

I had soreness in my hands today that I recognise as driving vibration triggered, yet I have only driven for ten minutes since Sunday. Is this latent pain from Sunday’s driving? WHAT ON EARTH COUNTS?

Love & Little Conclusion,
Caf
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