The single most important treatment for any diagnosis…

With wrinkles comes wisdom.

After 25 years of working with patients and observing the healing process, I have noticed a pattern for those who respond faster to treatment and those who recover more slowly.

As a young physical therapist, I conducted a lot of disability exams or Functional Capacity Evaluations (FCEs). The initial part of the exam consists of a series of questionnaires. The hundreds of questions and four-hour physical exam center around one query: “How much control do you have over your life?”

I realized early on, that simple question had a direct correlation to how the individual would eventually perform functionally. Those that responded that they had, “no control over their life,” were unable to function. Those that responded, “high/full control over their life,” could complete activities that were above what you would expect from their injury level.

How would YOU answer, “How much control do you have over your life?”

Initially in my career, I was baffled by what I thought was a ridiculous question and wondered why it was even asked. It did not take me long to research and read everything I could to find out as to why it was so important. I did not need to spend hours assessing and compiling what a patient was able to do. All I needed was the answer to that one pivotal question.

When you have control over your life, YOU are in charge. You feel secure and can make a solid decision. When you have no control, you feel lost, uncertain and lack confidence. Healing is not a passive event, it is an active one.  You MUST be in control.

I read everything I could about pain and the psychology behind it. The stimulus of pain is only half of what you may actually experience. The other half is how the brain interprets that stimuli.(1,2,3) For example, when you put your hand on a hot burner, that sensation, is a stimulus that goes to your brain and then your brain interprets it. If you have past fears, memories, anxiety about a certain stimulus, your brain then interprets a greater pain response. In other words, you will actually experience increased pain.(1,2,3,)  If your brain interprets that stimuli with positive emotions; you will feel less pain. In fact, if you are distracted, you may feel no pain at all. 

Another interesting, but not surprising finding, is that negative thoughts including anger, depression, fear, blame, failure and helplessness, all lead to slower healing and an increased feeling of pain. Positive thoughts of excitement, happiness, understanding, and feeling in control, lead to a decrease in pain and a more positive healing response.(1,2,3)

Many times, I would have two different people with the exact same surgery have a completely different experience. The patient with a positive outlook would have a quicker healing time for their incision and less pain. While the patient with a less positive outlook would have slower wound healing and increased level of pain. One may blame a lot of things like general health, smoking, etc., but the one thing that always stood out was their psychosocial well-being. 

For example, one individual was excited about moving onto the next activity in their life. The other individual was negatively focused and bitter about their circumstances. Perhaps someone else was at fault, they were injured at work, they had no control over their treatment plan, or their benefits were being held unjustly. If this patient had a different outlook their healing would too. This patient needed to feel empowered to heal properly and more swiftly.

What does it mean to empower a patient? As medical professionals, I believe it is the one GIFT we can give our patients during their treatment beside relief from pain. Empowerment puts the patient back in the driver’s seat so to speak. It gives them control and power over their ultimate perspective on their healing and that is the most important detail. NOT our specific treatments. The best hospitals, physicians, clinicians, and treatment protocols, are the ones where the patient truly has faith in and believes in their care and that they feel in control.

The critical and most important treatment is patient empowerment – helping the patient to be in control.  

In my next article I will outline how this is done and how we can also do the opposite!

1.Buscemi, V. (2005) Pain and Emotions https://www.upwardbackpainstudy.com/single-post/2015/12/01/Pain-and-Emotions

2. Hofbauer, R. K., Rainville, P., Duncan, G. H., & Bushnell, M. C. (2001). Cortical representation of the sensory dimension of pain. J Neurophysiol, 86(1), 402-411.

3. Villemure, C., & Schweinhardt, P. (2010). Supraspinal pain processing: distinct roles of emotion and attention. Neuroscientist, 16(3), 276-284. doi: 10.1177/1073858409359200