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This is the third installment in a series of four articles on narrative-based medicine, a protocol for building the therapeutic alliance that rests on holistic principles and addresses shortcomings in the evidence-based medicine and biopsychosocial models of practice. In the two previous installments, I introduced the core ideas of narrative-based medicine and compared it to evidence- based medicine and biopsychosocial models. This is a more practical piece, in which I provide a real-case description, an outline of the common approaches to the patient, and an example of how a narrative-based practice would work. This article is designed partly as an exercise, so as you read, you will find suggestions to stop, take notes, and only then read on. This exercise should offer a sense of how narrative-based medicine is meant to be applied in a practical setting, and is followed by observations on how this differs from more conventional approaches. CASE STUDY The case description and all details that follow are real and used with permission. Names and any identifying details have been removed, although some details have been summarized for length. Case Notes Forty-year-old female, average weight/BMI. Sedentary lifestyle; desk job. Old cervical injury (C6 bulge). Hypermobile but functional, has not been assessed for Ehlers-Danlos. Visibly weak periscapular muscles with scapular winging, shoulder instability, and frequent mild pain on affected (right) side. Lower back pain for several months following known strain from heavy lifting. No other serious health complaints. Patient presented with new symptoms including acute pain in the right posterior forearm and hand, refractory to analgesics (painkillers). Awakens most mornings with acute pain, as well as stiffness and dull pain in most finger joints, occasionally with redness and mild swelling (sausage finger description). Occasional Raynaud's syndrome in fingers and toes triggered by minor environmental temperature changes. Rheumatology blood work negative; thyroid normal, all other blood work normal. No obvious physical or postural triggers and no other recent injuries. 40 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 1 education | SOMATIC RESEARCH Narrative Medicine in Practice By Sasha Chaitow, PhD Treatment Ten minutes infrared radiation; 10 minutes TENS (transcutaneous electrical nerve stimulation) applied to upper back; 15 minutes shock-wave therapy (patient consulted first); 30 minutes massage. Following the session, the patient said she felt largely relieved of the discomfort, and telephone follow-up during the week confirmed the pain had not returned. Several months later, it had still not returned. EVIDENCE-BASED MEDICINE APPROACH Best evidence-based medicine practices recommend incorporating clinical experience, the latest evidence, and patient preferences. Experience and training will differ from one practitioner to the next, as will familiarity with the evidence. This therapist was familiar with the patient, but this set of symptoms was new to both of them. Ideally, this therapist should have sent the patient for imaging to see the state of the old neck injury, and in consultation he should have followed a sequence of CHRISTINA WOCINTECHCHAT/UNSPL ASH.COM

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