When the Pain Won't Go Away: Tips for Treating Difficult Pain Cases

Question: What can I do when my treatments are not creating the desired results for patients with pain?

This is a great question! We have all been there with certain patients or cases. We want quick and miraculous results 100 percent of the time, yet it doesn't always work that way. What can we do when the frustration strikes you and/or your patient?

Factors at different times of the treatment protocol may inhibit the healing / results from occurring the way we expect. These inhibiting factors can present before, during and/or after treatment encounters.

Are We Set Up For Success?

I believe our thoughts and intentions have significant influence over our actions and outcomes. Just as we acknowledge the power of placebo, our interactions with the patient may push us toward success or failure before the treatment starts.

The first thing I check in with is myself: Am I properly prepared to treat this case? This is an opportunity to check in with myself about multiple aspects of preparation for this patient relationship:

• Have I done enough research and study to appropriately treat this case?
• Do I believe in the patient's ability to heal?
• Am I distracted from being clear and present in any way?
• Have I looked at this patient's full health picture for all possible associated factors / causes?

Relationship & Communication

My next step is to assess the patient and the interaction between us:

• Does the patient believe they can heal?
• Are they ready to take their health back into their own hands and accept responsibility for their future?
• Is this patient invested in their health outcomes?
• Is there a healthy, mutual respect and trust between patient and practitioner?
• Are the patient's goals of care in line with the practitioner's?
• Is the communication between you and your patient clear and honest?
• Is there any reason that this patient may not want to fully improve?

This last question can be a tough one for any of us to acknowledge, but circumstances exist whereby patients may have increased burdens from better health. I have seen situations in which decreased physical or financial support could result if they became fully healed from their ailments. Relationships with loved ones may shift or change when they become independent from pain. Without overcoming these potential hurdles prior to treatment, achieving positive outcomes will be challenging.

What If My Treatment Is Not Creating Any Change?

The first two things that come to mind:

1. Our timeline for expectations may not be accurate. This means we have to be relaxed, patient and confident. The body needs more time and/or therapy to respond as expected.
2. The treatment is not completely correct for the case. Reassessment of the diagnosis may bring more clarity, and referral is possibly warranted to gather additional information.

What If My Treatment Only Achieves Temporary Results?

This seems to be the most common issue with practitioners. The recurring pain or symptom can make all parties involved feel as if you are living in the movie "Groundhog Day," with each checkup seeming like the one prior. One of my mentors taught me that if you can feel better with treatment, it is possible to consistently feel that good as long as you identify all the components to the imbalance. I like to use this opportunity to educate my patient.

In the case of pain, I explain the cause-and-effect relationship. The cause of injury is different from the location of injury. In cases in which we see this temporary result scenario, I suspect we are treating the damage to the tissue well, but the reason the damage is occurring continues to aggravate the condition. We need to search for underlying factors or causes that are creating the problem, also described as treating the source.

While there are more potential underlying causes to investigate than this article has room for, here are a few ideas for where to start from examples I personally see often in clinic:

Posture and Movement Imbalances:

Take a whole-body perspective and assess how the body is responding to gravity:

• How are the joints of the body stacking up?
• Is there a reason increased workload is directed to this site of injury?
• How is the body functioning above and below the site of the symptom(s)?
• Is excess / deficiencies / stagnation occurring along the channel of the symptom(s)?
• What is happening in the associated channels / organ pathology?

Chemical Imbalances: Certain chemical imbalances can alter the body's ability to heal. In these cases, we need to customize the treatment plan and prognosis to account for the imbalances. Examples include:

• Heat stagnation or systemic inflammation
• Jing and/or lymphatic system weakness
• Kidney / liver issues or detoxification deficiency
• Metabolic issues such as diabetes
• Dietary / lifestyle habits such as alcoholism, or consumption of low-quality / processed foods
• Dehydration
• Digestive qi weakness
• Hormonal imbalances

Emotional Stress Imbalances: Finally, we know many of our patients are depleted and overstimulated these days. In cases of depletion, whether qi, yin, yang, blood, wei or jing, we need to assess what kind and how much treatment they can best adapt to. Focus the herbal prescriptions and lifestyle recommendations toward supporting these depletions or excesses with which the patient is presenting.

Take-Home Points

We all get challenged with difficult cases and slow-to-respond patients. I hope this article emphasizes the holistic nature of TCM and supports your understanding of where to start with another jumping-off point. Remember, the lack of result from a treatment is a type of finding, similar to a test result. This can help us understand more about the patient and make a greater impact on their whole health, rather than just treating the symptom.

Editor's Note: Ask the expert! Have a question for Dr. Dillberg about this article or another topic? Email him at dustindillberg@gmail.com. Your question may be the subject of a future column.