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So this is something that's been bothering me a lot recently. I have a great deal of negative counter-transference to pain patients. I understand exactly why. My medical records read like those of your typical intractable pain patient. But I've never touched a narcotic. And I manage to not only stay active, but do a credible imitation of a strength athlete.
I could write a novella on the underlying sources of it. From disdain at their choice to let NMSK (neuromusculoskeletal) dysfunction rule their lives. To resentment at their (often successful) attempts to get pity, while my struggle often goes unappreciated or even doubted by people who refuse to believe I do what I do despite my physical limitations (which lie beneath the skin). To annoyance at the entire medical profession that chooses to focus on legitimizing and emphasizing the psychological and subjective experience of pain over treating underlying dysfunction, leaving guys like me in the lurch because our profession has never turned our resources both academic and clinical to maximizing of function and minimization of dysfunction.
Logically, I can acknowledge the fact that we all make choices, and that there are costs and benefits to each path one can take. I believe that the costs of hours in the gym, faking it until I puke or almost pass out, reading kinesiology and exercise phys literature to see if I can develop my own physical therapy, using myself as a lab rat, and constantly sore muscles instead of arthralgia and radiculopathy, are far outweighed by the benefits of remaining active and having a shot at a relatively normal life. And I can see why others might choose a path of lesser resistance. Overcoming dysfunction is a full-time job. The pay is sporadic and often meager, and it seems like there are more and more bills due every day.
But all that said, every time I encounter a pain patient, the only thing that runs through my head is the Lance Armstrong quote from Dodgeball.
I do my conscious best not to let my feelings come to the surface. And for an MS4 I'd say I'm pretty darn good at that. But I'm sure unconsciously it still affects my patient interactions.
I'm also concerned because, being interested in mind-body as I am, and with special interest in the psychology of rehabilitation, I'm afraid I might never approach things as objectively and openly as would be needed.
On the flip side, I think my experiences make me a perfect candidate to attempt to reform the way medicine, as a profession deals with pain. You can't treat pain because there's no such thing as 'pain disease' (well, mostly there isn't). Only underlying dysfunction which leads to pain. You can on the other hand, alter the way we process the signal of pain cognitively and emotionally. And ultimately, pain is an adaptive process, a signal of the fact that something isn't quite right. By using mindfulness and cognitive-behavioral techniques, I believe we can not only reduce the negative impacts of pain on individuals, but also better utilize its positive qualities in rehabilitation.
As a personal trainer I use cognitive-behavioral techniques for motivation (e.g. "exercise makes me tired." "of course it does, you have no work capacity. But if you exercise, you'll find you build your work capacity and end up having more energy for every day things."). And use mindfulness techniques for rehab/prehab (i.e. lightweight exercises with the focus not on weight, sets, or reps, but feeling your body go through the healthy motion, rather than the dysfunctional one, and learning to move every day in all activities in a biomechanically correct way).
Anyway, long rambling rant. What I'm getting at, is, given that I understand the reasons for my counter-transference (although I'm sure therapy will increase it further), and that ultimately I feel that my perspective is justified (and don't think that will change), I'm concerned that I may never be able to do justice to the class of patients I'm most interested in working with. And I also wonder if maybe my feelings of what I can bring to 'rehabilitation psychiatry' (for lack of a better word), are wrongly bound up in a feeling of self-importance.
Blah.
I could write a novella on the underlying sources of it. From disdain at their choice to let NMSK (neuromusculoskeletal) dysfunction rule their lives. To resentment at their (often successful) attempts to get pity, while my struggle often goes unappreciated or even doubted by people who refuse to believe I do what I do despite my physical limitations (which lie beneath the skin). To annoyance at the entire medical profession that chooses to focus on legitimizing and emphasizing the psychological and subjective experience of pain over treating underlying dysfunction, leaving guys like me in the lurch because our profession has never turned our resources both academic and clinical to maximizing of function and minimization of dysfunction.
Logically, I can acknowledge the fact that we all make choices, and that there are costs and benefits to each path one can take. I believe that the costs of hours in the gym, faking it until I puke or almost pass out, reading kinesiology and exercise phys literature to see if I can develop my own physical therapy, using myself as a lab rat, and constantly sore muscles instead of arthralgia and radiculopathy, are far outweighed by the benefits of remaining active and having a shot at a relatively normal life. And I can see why others might choose a path of lesser resistance. Overcoming dysfunction is a full-time job. The pay is sporadic and often meager, and it seems like there are more and more bills due every day.
But all that said, every time I encounter a pain patient, the only thing that runs through my head is the Lance Armstrong quote from Dodgeball.
I do my conscious best not to let my feelings come to the surface. And for an MS4 I'd say I'm pretty darn good at that. But I'm sure unconsciously it still affects my patient interactions.
I'm also concerned because, being interested in mind-body as I am, and with special interest in the psychology of rehabilitation, I'm afraid I might never approach things as objectively and openly as would be needed.
On the flip side, I think my experiences make me a perfect candidate to attempt to reform the way medicine, as a profession deals with pain. You can't treat pain because there's no such thing as 'pain disease' (well, mostly there isn't). Only underlying dysfunction which leads to pain. You can on the other hand, alter the way we process the signal of pain cognitively and emotionally. And ultimately, pain is an adaptive process, a signal of the fact that something isn't quite right. By using mindfulness and cognitive-behavioral techniques, I believe we can not only reduce the negative impacts of pain on individuals, but also better utilize its positive qualities in rehabilitation.
As a personal trainer I use cognitive-behavioral techniques for motivation (e.g. "exercise makes me tired." "of course it does, you have no work capacity. But if you exercise, you'll find you build your work capacity and end up having more energy for every day things."). And use mindfulness techniques for rehab/prehab (i.e. lightweight exercises with the focus not on weight, sets, or reps, but feeling your body go through the healthy motion, rather than the dysfunctional one, and learning to move every day in all activities in a biomechanically correct way).
Anyway, long rambling rant. What I'm getting at, is, given that I understand the reasons for my counter-transference (although I'm sure therapy will increase it further), and that ultimately I feel that my perspective is justified (and don't think that will change), I'm concerned that I may never be able to do justice to the class of patients I'm most interested in working with. And I also wonder if maybe my feelings of what I can bring to 'rehabilitation psychiatry' (for lack of a better word), are wrongly bound up in a feeling of self-importance.
Blah.
