Issue link: https://www.massageandbodyworkdigital.com/i/494122
58 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 DON'T INDUCE OR EXACERBATE TREATMENT- RELATED STRESS For the massage therapist, preventing treatment-related stress starts with the intake process. During your intake, do you ask only questions specifi c to pain, or do you give the client an opportunity to discuss his entire experience around the pain? Here is an example of a question that leads the conversation toward a biomedical slant: Therapist: "Where is the pain?" Client: "In my neck. Right here. Sometimes it goes down my arm." Though this is an important question to ask, it is specifi c only to the physical pain (biomedical approach). If not followed by questions that move the intake process toward the client's psychological and social experience of pain (biocultural approach), it may induce treatment-related stress. Open-ended questions provide an opportunity for the chronic-pain sufferer to fi ll in the story, allowing you to move toward framing pain in a biocultural way. Here's an example: Therapist: "Tell me more. When did it start? How long have you had it? What have you tried?" Client: "Well, I was driving, and when I came to this intersection, I was T-boned. I didn't feel the neck pain right away, but it started to get bad about two weeks later. The doctor sent me to physical therapy and that just made it worse. I was thinking about going to a chiropractor, but my sister- in-law, who is an orthopedist, said not to. But my friend goes to a chiropractor, and it seems to help him. What do you think about chiropractors?" So far, the client has talked about the driver who hit him, the doctor who treated him, the physical therapist who didn't help him, the sister-in-law who doesn't want him to go to a chiropractor, and the friend who does. The therapist can begin to understand that the client's pain experience includes signifi cant confusion and frustration, and can then acknowledge and validate the client's emotional experience, thereby reducing a client's treatment-related stress. The intake process is not the only potential hazard for overemphasizing the biological side of chronic pain. Once you have the client on the table, especially if you practice massage from an orthopedic or sports philosophy, be careful that your desire to "fi x" chronic pain doesn't turn you into a mechanic. For example, when I became certifi ed as a neuromuscular therapist, I was ready to fi x the pain of all chronic- pain sufferers. At the time, I was working for a chiropractor who sent me a client with chronic neck pain. I did a structural analysis, mapped out a plan of attack, and worked the muscles the way I thought they needed to be worked. It was 100 percent biomedical. Later that night, the chiropractor relayed some feedback to me regarding the chronic neck-pain sufferer. He had asked her, "How was the massage?" She snapped back: "That was a massage?!" Needless to say, I stressed her out, and she didn't come back to see me. No one, and no one discipline, has a cure for chronic pain. It's complex and requires the massage therapist to put her belief in her specialty training and/or massage abilities second to the reality that she is only one component of a pain-management system. Lesson Lesson 1