Complete Your CE Test Online - Click Here Pain complaints Assessment of a client’s pain complaints requires obtaining a history and current pain status by asking appropriate questions along with palpation examination, postural analysis, range of motion testing, and muscle strength/weakness tests. Ask the client to tell you about his or her pain issue if the person seeks a therapeutic pain relief session. Appropriate questions to provide the therapist the knowledge to devise a treatment plan include: ● ● Does you know what caused the pain to occur? ● ● How long has the pain been going on? ● ● Is the pain acute or chronic? Explain the difference to the client. ● ● Is the pain constant or intermittent? ● ● Does the pain increase when you do a particular activity or movement? ● ● Has the pain spread to other body areas over time? ● ● On a scale of 1 to 10, can you rate the intensity of the pain? ● ● Describe the pain: Is it aching, burning and so on? ● ● Touch any current areas where you are experiencing pain. ● ● Have you experienced any range of motion limitations because of pain? ● ● Has your pain been diagnosed by a doctor? ● ● Did a doctor prescribe treatment? ● ● If so, have you received previous treatment and by whom? ● ● Did any previous treatment help or hurt? In what way? ● ● Are you still receiving treatment? ○ ○ If you are receiving treatment, why have you come to me? If your client has multiple pain complaint areas, you will need to ask these questions for each area. Once you have obtained a written and verbal description of pain complaints from your client, inform the person that you need to complete your assessment through soft tissue palpation and range of motion testing for any limitations in movement. You must determine a client’s treatment plan according to your own skill level and knowledge of pain relief techniques. Describe your preliminary treatment plan to the client for approval before proceeding with any pain relief session. Describe how you will use the information derived from the person’s answers, written pain history, postural analysis findings if performed, and any range of motion test results to implement your treatment plan. Make the client aware that your plan may change during the session, depending on the condition of the person’s soft tissue upon palpation and response as you perform the treatment. Tell the client that all subsequent session plans will be determined by the results of each treatment completed. Explaining the rehabilitation process for pain relief treatment While any improvement or elimination of soft tissue dysfunction or pain will vary with each client, there are guidelines for rehabilitation that can help clients create realistic expectations of pain relief from massage therapy treatment. Understanding the rehabilitation process will help them have patience in obtaining positive results and should reduce any doubts about the merits of massage therapy for their condition. Clients sometimes do experience an immediate reduction or elimination of pain, but chronic or acute soft tissue conditions more often than not require repeated cumulative treatment, with steady pain reduction as treatment progresses. This is especially true of chronic pain complaints. Most clients understand that longstanding, enduring pain will not magically disappear with a single one-hour massage session, but clients who don’t need to have a more realistic expectation of results. While immediate, complete cessation of pain is always a goal, if that was always the result, you would have people lined up outside your door. The reality is that rehabilitation of soft tissue dysfunction is dependent on the severity of the condition, how frequently treatment is obtained, each individual’s physical response, whether the client is engaging in activities that exacerbate the condition, making changes in work or personal habits, postural corrections, therapist skill level, or permanent physical disabilities that exist for a client. Explain that client awareness and participation in their recovery by performing helpful stretches or strengthening of affected areas between massage therapy sessions may also affect the outcome. It may also speed the recovery process and should be encouraged. Educating your clients about these characteristics for soft tissue rehabilitation may help them provide you with helpful feedback and garner their confidence by recognizing your professional knowledge as a health care provider. When your clients have a more informed awareness of the many things that can determine their rehabilitation, you can offer the following guidelines on how the rehabilitation process might work. If massage therapy is effective treatment for clients’ pain, they should notice a reduction of pain levels usually within the first five sessions, although this is not set in stone. You will have more chance for success with your clients if they will commit to receiving this many sessions. Generally, for massage therapy to have effective pain relief results, clients need to be encouraged to receive session work two to three times a week. Clients should be made aware that if they can only receive a treatment once a week, then chances for complete pain recovery will be limited, their pain symptoms may only be temporarily relieved, or the rehabilitation process may take much longer. After five sessions, if there is no improvement whatsoever, discuss whether further treatment is warranted. It would not be unethical to continue treatment because improvement may take longer with some clients, but this is a decision clients must make. Other options for their care may be to refer them to another massage therapist with particular skills you do not possess or to a different type of health care provider. Many clients will experience relief with their first session. Most will notice less and less pain with regular session work. It is important to identify a client’s pain scale level before and following each session to gauge improvement. Clients should understand and monitor their pain levels after treatments so they may provide you with necessary feedback at their next session to determine their progress and future treatments plans. Be sure to tell your clients that it is possible they will see even greater improvement two hours, six hours, or 24 hours after treatment and should report it at the next treatment. Ideally, during the course of treatment, a person’s pain will continue to subside, sometimes to the point where he or she feels no pain at the end of the treatment. While the pain likely will return later, ask the person to monitor how long he or she remains pain-free between sessions before the pain returns. As the rehabilitation process continues, people should go longer and longer before the pain returns following sessions. Another sign of improvement is that even when pain does return, it is at lesser levels. The goal is that eventually, improvement will continue until a client experiences no pain during, after or between treatments. At this point, a suggestion for maintaining clients’ pain-free status is to have them continue to come in for treatment for two additional weeks. If they continue to remain pain-free, it is likely they no longer need further treatment except for maintenance. If their pain condition flares up again within a few weeks or a month, have them schedule a session as soon as possible. Generally, one or two sessions will return them to their pain-free status. Suggesting regular massage therapy as often as they desire or are able to schedule will help keep their soft tissue in a healthy condition. A rule of thumb is to recommend once-a-month treatments as a minimum to maintain a healthy status. Massage therapy can reduce pain that is not fully caused by soft tissue dysfunction but not eliminate it. Pain from previous injuries, surgeries or physical conditions may be improved to a certain level that can be maintained. Clients should be made aware of this possibility when it is appropriate. Even so, many clients are satisfied with attaining a level of rehabilitation that has significantly reduced their pain; frequently, it is the only way they are able to manage their pain. Page 12 Massage.EliteCME.com