We like to measure things to document change. In the classroom, we measure our grades based on a scale of 0 to 100. You would always prefer your kids to score closer to 100 instead of 0. We track how our home values are increasing on real estate websites. In healthcare, we like to track and document pain and functional improvements.
Pain scales are what you’d expect, they measure a person's pain. We can track low back pain at its best, average, or worst. We ask you questions to have you describe what your pain is like first thing in the morning, around lunchtime, and in the evening. How does your pain change with activity, positions, and movement?
Pain is an indicator of an injury and helps us classify your severity level. But it does not always tell us about your neck and back pain. If we asked you what your pain is like at best, average, and worst, you might report a number of 0/10 at best, 3/10 on average, and 7/10 at worst. This does not tell me what percentage of the day your pain is a 0/10 or a 7/10. It does not tell me how your pain changes throughout your work day. Are you pain free the first hour of the day or the first six?
It will help me to explain and document if you are improving with treatment if you first reported your pain to be a 7/10, then after a week of treatment it decreases to a 4/10. Pain is a component of your recovery but it does not tell us the entire story. We also look at functional scales. What can you do and what can't you do. If it causes you severe pain to brush her teeth in the morning, that tells me a lot about the level and severity of your injury. If a simple activity is almost impossible to perform, then your injury is severely limiting all activities in your day. It is making it impossible for you to perform almost any home, work, or recreational activity.
During the course of treatment, we are going to document your pain and your functional abilities. We are going to identify what your injury is preventing you from doing, and what you are able to perform as you improve through treatment. If we are using the flexion and distraction tables, we will pay attention to how far your back can flex and move without pain. We will compare the pain free movements to previous visits and treatments. Likewise, we track changes to the time and pounds of pressure that your low back tolerates during spinal decompression treatments. With improvement, you will notice less of a stretch with the same pulling force, and that it takes more pounds of pressure to produce stretching.
Our goals of treatment are not only to get you out of pain, but also to return you to your normal activity activities of daily living, work, and recreational activities. We also want to strengthen and protect the injured area with exercises, so the injury does not recur. We do not consider it a successful treatment if your pain returns within a couple weeks or the first time you work in the house.
Goals of treatment are different for every patient. However there are basic and important aspects to every recovery including pain and functional abilities. We are going to track these with pain and functional scores. Testing throughout your treatment helps to gauge your functional strength, endurance, and abilities which help us identify your functional improvements for your home, work, and recreational goals.
Pain often leads people to our clinic. It is the biggest motivator for seeking treatment, but is is not the best measurement of your progress or improvement. Yes we care about your pain, but we care more about your functional abilities.