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Persistent Pain Management: A PT/Patient PartnershipJohn DeWitt, PT, DPT, SCS, ATAnthony HamiltonOPTA Scientific Symposium, October 20th, 2018

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Nothing about me without me.

— Valerie Billingham, Through the Patient's Eyes,

Salzburg Seminar Session 356, 1998

TRUSTTRUST

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10/13/2017

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4

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8/24/17 9/22/17

22 year old male with 2 yr history of complex regional pain syndrome

6 6

Oct ‘15 Jan ‘17Dec ‘15 May ‘16 Oct ‘16 April ‘17

Inversion ankle

sprain(9/23)

Poor outcome

with PT (10/9)

PT Eval 5/20

(3 visits)

Pain management:

1(11/02)

Epidural injections

Respiratory arrest

from meds 1/18

PT Eval 1/12 (22

visits)

PT resumed 1/24

Hammer Toe ORIF

4/21

ED Septis

4/26

PT (6/21)

Pain Management 2

4/11 (SCS

recommendation) Pain Management 2

12/03 SCS

recomendaed

ED (pain) ED (pain)

Pain management: 1

12/3

ED Pain 8/8

Return to PT 8/24

June ‘17 Sept ‘17

PT 9/22

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7

Affective bond

Self reported HealthSymptoms Status

Quality of Life

Bordin, 1979, Stacey, 2001, Arterburn 2012, Kao 1999, Perau 2004

50% of

positive

outcomes

8Hall, 2010

Treatment satisfaction

Pain

Physical Function

Pt. satisfaction

Depression

General health status

Positive feedback

Answer patient's

questions

Providing clear

instructions for home

Working Alliance Inventory

(WAI-S), Hatcher 2005

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1010

Oct ‘15 Jan ‘17Dec ‘15 May ‘16 Oct ‘16 April ‘17

Inversion ankle

sprain(9/23)

Poor outcome

with PT (10/9)

PT Eval 5/20

(3 visits)

Pain management:

1(11/02)

Epidural injections

Respiratory arrest

from meds 1/18

PT Eval 1/12 (22

visits)

PT resumed 1/24

Hammer Toe ORIF

4/21

ED Septis

4/26

PT (6/21)

Pain Management 2

4/11 (SCS

recommendation) Pain Management 2

12/03 SCS

recomendaed

ED (pain) ED (pain)

Pain management: 1

12/3

ED Pain 8/8

Return to PT 8/24

June ‘17 Sept ‘17

PT 9/22

• Slow and progressive loading

• Loves the leg pressGraded

Exposure

• Education to break up WB activityActivity Pacing

• EMS

• Walking and logGoal Setting

• Prioritized toe extension to improve plantar surface time

Problem Solving

• “Hurt does not equal harm.”Cognitive

Restructuring

• Focused on career opportunities and school

Attention Diversion

• Bouncing ideas off each other, what works, what doesn’t work

Maintenance Strategies

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10/13/2017

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Thank You

wexnermedical.osu.edu

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