Jul 30, 2019

Interview Transcript

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Physical Therapy and Pain in the ER

One of Troy's biggest frustrations in the ER is patients suffering from pain. He prescribes what he can to help, but the patients often return still in pain. He wants to help, but the recent fears related to the opioid epidemic can cause him to hesitate to prescribe pain medication.

Enter Keith Roper, PT, DPT is a physical therapist that works in the ER at University of Utah health to help patients with their pain without the use of drugs. There are roughly sixty emergency departments in the U.S. that have an embedded physical therapist. These specialists have extensive training that makes them uniquely qualified to treat pain.

Pain is Okay and Doesn't Always Need Medication

Pain is a very complex sensation. It is not merely a "tissue issue." Pain is a complete neurophysiological sensation that is more than just a physical injury. How a patient experiences pain is an interplay of factors ranging from emotion to physiology to immunology.

The classical method is for doctors to treat pain as "the fifth vital sign." Patients came in reporting an amount of pain on the pain scale. The doctors then aimed to get that patient's pain to zero. This often included prescribing enough pain medication to reach that goal. Unfortunately, some of these interventions can be counterproductive to actually treating the root cause of pain.

"I know you're in pain, but it's okay," Keith will often tell his patients. The goal is not to get that pain score to zero, but to reassure patients that pain is a part of the healing process and to not assume it's a sign of something severe.

The Best Way to Treat Pain: Move It

"If it hurts, don't do it," may seem pretty intuitive to most of us, but Keith assures his patients that movement is the best thing a person can do to help an injury heal and manage pain. After a patient is screened for more serious complications from an injury, pain itself is not an indicator of tissue damage.

People often fear that they may cause more damage if they continue to move something that hurts. This is not the case. Activity is the best thing you can do to heal after an injury, and a physical therapist can help you reframe your relationship with pain and prescribe a plan to help you get moving through the pain safely.

Pain is Good, but it Can Become Too Sensitive

Pain is actually a good thing. It's the body's alarm system. Pain tells us to pull our hand away from a hot pan before the burn gets worse. Pain tells us when we've pushed our body too hard and need to rest. Pain keeps us safe. In fact, a rare genetic condition can lead people to be born without the ability to feel pain. Most of these people die before age 20 because their body is unable to express injury and protect itself.

After an acute injury or certain chronic pain conditions, the body's pain system can become too sensitized to stimuli. The simple brush of a feather can cause an excruciating response for an over stimulated nervous system. It's important to remember that the relationship between pain and tissue damage is not linear. Just because something is extremely painful does not mean the physical injury is also severe. It may just be a sensitive nervous system.

Physical therapy can reassure you it's safe to move - even when it's painful - and train you to get moving again safely.

Treat Chronic Back Pain by Moving More

Pain is pretty common for people with desk jobs. Being hunched over computers day in day out can lead to chronic pain in the upper back and shoulders. Troy has personally experienced this with his job for the past 15 years. What causes this pain and how can you get relief?

Keith explains that nerves need three things to be happy:

  1. Blood flow
  2. Space
  3. Movement

If nerves lose blood flow, become compressed, or stationary for too long, they'll start to send pain signals to the brain. The nerves are telling the brain that they need to move.

For example, if you're sitting in a hard chair for a long amount of time, your backside will begin aching. The typical office worker's upper back pain is similar. You are holding your back in the same position for a long time without moving.

What can make the pain even worse is when a person sits in the same static position day in and day out. Every time your body experiences that upper back pain, it becomes more sensitive to the situation. The next time you sit at the computer, your body will tell you sooner. This can get to the point where people will start feeling pain the moment they sit down in their office.

How can someone alleviate their painful back pain?

"Get moving, change your position," says Keith.

Movement allows for the nerves to get the blood, space, and movement they need. Stretch throughout the day. Change positions often. Get up and walk around every hour.

"A lot of people tend to wait until the pain goes away before they move," says Keith, "When actually the most persistent pain needs movement to heal."


ER or Not: I Almost Drowned

Say you're out having some fun swimming. Maybe at a pool or a lake. Suddenly, one of your friends find themselves under water. The struggle a bit and inhale a bunch of water. They get to shore, everything seems fine, but the almost drowned! Should you take them to the ER?

According to Dr. Madsen, it really is a judgement call. The biggest concern with any liquid getting into a patient's lungs is the possibility of aspiration, or getting water in the lungs. There's also a potential for a person to form pneumonia a few days after getting water in the lungs.

That being said, most of the time, an individual with cough up the water and be fine.

However, if the person lost consciousness or required someone to pump the water out of the persons chest, you should take them to the ER to make sure everything is alright.

Remember, no one will ever fault you for going to the emergency department, it's always better to be safe than sorry. When wondering if you should go to the ER, remember your ABC's. If there is any problem with a person's Airway, Breathing, or Circulation, you should go to the ER immediately.


Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy finds new faith in humanity after reading a study about people finding a lost wallet and Scot's baby saving blood saves a child in need.


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