Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Pain Is All In Your Head

I very frequently see patients who are released to transitional/light/alternate duty with limitations on sitting or standing for more than 15-30 minutes.

I sit and read these restrictions with the patient seated across from me in a straight back chair, without movement, for the past hour. I ask the patient if he/she needs a break, and he/she declines.

The patient takes a battery of psychological in a similar chair, sitting for hours, taking rare and brief breaks.

The patient drives or rides several hours to the office and then several hours home.

The patient_s true functional capacity appears to be much greater than what the records reflect.

How does this occur?

As from a functional capacity exam, limitations are also determined by patient complaints and requests/demands for medication. Those office visits are often brief, and little time is available for an extended observation of the patient.

By contrast, I have the patient in my office for ~5 hours, and he/she often finds the tasks laborious and boring. As a result, they are motivated to complete. Thus, they decline breaks, often remove their lumbar support, set aside their cane and _forget_ to limp, moan, guard and to take medication.

The true _functional capacity_ is determined by the context (setting) in which it is examined.

This behavioral observation of a patient should be obtained on any patient who claims chronic and unmanageable pain.

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