Feeling your patientÕs pain

Australian Medical Observer (page 31)

10 June 2011

Scenario

Dr Louisa Yim discusses a new skill she has brought to her practice.

ÒThe doctor of the future will give no medicine, but will interest his (or her) patients in the care of the human body, in diet, and in the cause and prevention of disease.Ó - Thomas Alva Edison.

I KNEW general practice was my calling while working as a hospital intern.  

Soon after completing the general practice training, I wanted to develop further special skills. After completing the diploma in obstetrics and also a certificate in skin cancer medicine, I felt that there was still something missing in my clinical practice.

One thing that I have learnt over the years is that as general practitioners, we may not be able to provide patients with all the answers.  Some patients may leave the consultation room feeling rather disappointed or not sure what to do.  Hence I can understand why some patients are drawn to an alternative or holistic approach.

ÒOur hands have healing powersÓ

Little did I understand this statementÕs true meaning until I completed the Certificate IV in Massage Therapy with the Melbourne Institute of Massage Therapy. To date, I am the only medical practitioner to enroll and finish this course, and my clinical teacher and I wondered whether there is a place for massage therapy in general practice.

One day in my practice I saw a 70-year-old Italian woman with chronic neck and shoulder pain.  She has been to several other doctors and decided to see me for another opinion.  She was told that she had osteoarthritis and had been prescribed topical and oral anti-inflammatories.  

After history taking and a physical examination, I reviewed her cervical spine x-ray, which showed degenerative changes with narrowing of disc spaces.  She also demonstrated classic neuropathic symptoms and signs.   A CT scan of her neck later confirmed moderate to severe spinal canal stenosis at several levels.

I offered a number of management options, including changing her medications to analgesia more suited to neuropathic pain, physiotherapy and also a referral to a neurosurgeon. I emphasised the fact that we might not be able to get her pain-free, but our goals were to minimise pain and improve function.  She agreed, but clearly she was in a lot of pain due to secondary muscular spasms.  

With her consent, I offered her a five-minute gentle neck and shoulder massage while she sat in her chair.  After application of some menthol gel, I began examining and palpating for regions of maximal muscular spasm.

Her right-sided trapezius muscle was swollen and tender. Effleurage, petrissage, kneading and gentle but firm pressure were some of the massage techniques that I applied.

I really did not expect such a reaction from her.

Soon after the treatment, she burst into uncontrollable tears. She later confided that throughout her life, no-one - no doctor or nurse, no family or friends, has ever tried to help her like this.  No-one understood her pain and no-one has truly taken her seriously.   

She also revealed that she had been a victim of domestic violence. She had very little support from her family and her only son was involved with drugs and was diagnosed with a psychiatric disorder. She had been depressed most of her life and had neither time nor energy to look after herself.   This massage was cathartic and a real opportunity for her to explain her feelings. She was forever grateful and thankful.

In an ideal world, there would be no time restraints or financial restrictions.  In the perfect world, everyone will be treated equally.

Beneath the surface, there lies a human body.  A real person with his or her life stories, ready to share what he or she has seen, heard, tasted or endured.  

I have not carried out a randomized control trial in general practice but will certainly continue this practice of therapeutic massage, should I come across similar situations in the near future.  

So, is there a role for massage therapy in general practice?   Too touchy and feely for some?

I will leave that for you and your patients to decide.