Featuring Dr. Pamela Squire, MD, CCFP, DCAPM, ISAM, CPE

Video Title: Patient Case of Chronic Pain Treatment Duration: 3 minutes, 57 seconds    

Cindy is a 33-year-old nurse who had a motor vehicle accident three years ago.  

She was initially diagnosed with whiplash and received standard conservative therapy. She had simple analgesics, physio, massage therapy, and although she attended and did everything her doctor requested, over time, her pain really didn't improve.  

When she was assessed, we looked at a number of different factors. We looked at: What were the factors in her neck that were playing a role in her pain? Those turned out to be myofascial pain, so muscle tightness with trigger points.  

She had a lot of problems with posture. Her head was forward and that was putting a lot of strain on the muscles lower down in her neck. There might have been a problem with the facet joints in her neck, and that needed to be evaluated, as well.  

From a psychological perspective, since Cindy had stopped working, she'd really lost a big chunk of her identity. Work was important to her, and when she wasn't able to work, she wasn't quite sure who she was.

She'd had difficulty sleeping and had developed some problems with anxiety and depression related to an inability to really manage her pain and really carry on with her life.

Treatment for Cindy involved looking at the biological factors that were playing a role. It was recommended that she have treatment of her trigger points. This could be done by a local physician injecting them or done by an excellent physiotherapist who can also use intramuscular stimulation to treat those.  

Following that, her assessment would involve massage therapy, who may also be able to help her with a stretch program and self-management of the trigger points with a Thera Cane or other strategies.

Because Cindy had quite head-forward posture, there was some concern that that would be a problem should she go back to work, so a program was developed to help her retrain.

An occupational therapist was also brought on board to do an ergonomic work assessment of her work station at work where she was a nurse who often had to sit at a console and enter data into a computer.

Weight had become an issue for her, and it was important for her to learn how to make appropriate adjustments to her diet and to lose weight. She used to be a runner and couldn't run anymore because the jarring bothered her neck. An exercise therapist was brought on board to give her new advice for maintaining cardiovascular fitness.  

Cindy was also referred to a psychologist for some one-on-one counseling to help her develop new strategies. She attended a pain self-management program and thought that was one of the most helpful things that she did and through that program learned a lot of very important self-management skills.  

She learned how to set goals for herself. She learned how to meditate. She learned to develop a big pain self-management team that she could call on when she got into trouble. She developed a strategy for pain flares.

All of that gave her a lot more confidence in managing her pain. Cindy was also referred to a complementary physician who was able to give her some important advice about additional supplements that she found really helpful.  

Over the next few months, Cindy did improve. Initially, she said her pain wasn't really any better, but she felt she was much better with her pain. That was a result from accepting that she had pain and recognizing that whether she was gonna have chronic pain her whole life or not, she had to learn strategies to manage it. And when she did, it had a lot less impact on her life.

Over time, the other strategies also started to really change her pain and change her life. Three months later, Cindy began a graduated return-to-work program and worked part-time for six months, and then returned to work full time by a year later.

Presenter: Dr. Pamela Squire, Pain Specialist, Vancouver, BC

Local Practitioners: Pain Specialist