While many, if not most, injured workers have severe financial problems that threaten their security, there are numerous cases in which the individual does not wish to return to work: a. The family has begun to compensate for the financial difference, and, with social security benefits, it may not be mandatory that the patient again works. b. The patient may have formed a new relationship that promises financial security, and re-employment is no longer required. c. Choosing between poverty level existence or working long hours in pain, some will make a choice to avoid the pain. d. Many injured workers have performed manual labor since age 16 or before, having had little time with their family, and this may be the first opportunity for some semblance of a family life. e. They reside in a community (or family) in which disability is not uncommon, and they receive considerable support and encouragement ...
In my clinical experience there are actually two age groups which present problems of rehabilitation. The first group is the comparatively young (e.g. ages 30-40) males in manual labor positions who often have (or came from) families with one or more disabled family members *and* who themselves have no alternate skills for non-labor intensive occupations. Within a year of injury, these individuals acclimate to a sedentary lifestyle of watching television, gaining weight and inactivity aside from doctor visits and physical therapy visits. Dependency upon medication arises. These individuals can be readily identified and assisted if referred soon after injury. The second group is comprised of two subgroups, but they share in common their age ranges. This group is the age range of ~48-60 years of age. The first of these subgroups are those who are working to offset boredom and have no financial need to be in the workforce. Their motivation to confront their ...
The psychological examination of pre-surgical patients involves the investigation of the patient's a. Understanding b. Preparedness c. Expectancy and d. "Ghosts" A large number of pre-surgical (especially fusion candidates) very poorly understand what the procedure involves, and they need to discuss this with their surgeon but for a variety of reasons, they have not done so. Surgery is looming, and they have not retained what they were told about the surgery. In a related fashion, they are unprepared for the discomfort and limitations, of the timeframe for physical therapy and what they can do to increase their maximally benefiting (from diskectomy or laminectomy). They often believe that “old discs will be replaced by new ones” (sic). Even in the case of morphine pumps or stimulators, there can be the expectancy that this procedure will restore them to pre-injury health and that ...
Dialectical Behavior Therapy (DBT) has been shown effective with patients with borderline personality disorder, patients with bulimia, and patients with widely swinging and often highly inappropriate moods. In brief, whether genetic or learned, many injured workers lack the capacity for self-soothing (e.g. “calming down”) when confused, upset or disappointed. Unable to calm, they either attempt to curb the feelings with drugs or alcohol, verbally or physically attack a convenient target, and/or in some cases harm themselves. Since office visits are brief, and certainly not a place for psychotherapy, there are still approaches used in psychotherapy that you can implement: a. “Let’s step back and look at this situation we are in with your back (neck, shoulder, knee, etc)” allowing them a perceived distance from the immediacy of the threat. b. Distract them by bringing up important, but not necessarily ...
This Week's Topic: There is actually a four way relationship between sleep and pain: a. As you know pain can disrupt sleep onset, duration and architecture (structure of the sleep) b. Narcotic pain medication can change sleep architecture such that sleep is not restful/restorative. c. One of the cardinal signs of depression is a change in sleep architecture, most commonly early morning awakening and/or periods of seeking excessive sleep. d. Deprived of sleep, the experience of pain becomes less bearable and more incapacitating. There are, therefore, several things you should do: a. Order a psychological evaluation to determine if the patient is depressed and the source(s) of the depression b. Be certain that the examining psychologist is aware of the medication regimen, including pharmacy records ...
Recent Comments
