Chronic Pain

Hey guys,

My question this week is about a patient i had during the last week of my placement. I'm in musculoskeletal outpatients and my patient was a 60 yo man with OA of back, shoulder, knee and hip, he also had a skin lymphoma condition which had been succeccfully treated with chemo late last year, he had been getting physio for his shoulder prior to the chemo, but had to stop for his treatment.

On assessment he had widespread pain, the worst of which being 8-10/10 pain in his lower back, so bad that he occasionally passed out from the pain. He had a reduction in range and pain in all directions, and i could only use very very light pressure for my palpation and PAIVMS as he would jump and claim 8/10 pain with contact through his lumbar and thoracic spine.

As my tutor was completing a final assessment with another student, i wasn't able to get his feedback, however due to the chronic and severe nature of his symptoms, i was reluctant to perform manual therapy. I ended up doing 10-15 minutes soft tissue massage, followed by a heat pack over his lumbar spine for 20 minutes. Looking back i think perhaps i should not have done the soft tissue massage, as this is a manual technique and i don't want to make him reliant on manual therapy. I ended up referring him for hydrotherapy and booking a review in 3 weeks.

What i was wondering is what you guys think of this situation, would you have done the same as i did, or taken a different approach?

Thanks for the input, and all the entertaining and insightful blogs :-)

James