Having a ‘protective force field’ around the painful side of the body is a reasonably understandable response for someone with complex regional pain syndrome (CRPS). Why would you want someone to come near, let alone touch an extremely sensitive part of your body?
I have come across this phenomenon with some consistency in people with CRPS. They may be acutely aware that they don’t want you to come into or invade their space or their body language infers this.
Traditional therapeutic evaluation of a painful limb i.e. jump straight into a physical assessment of the affected body part, essentially flies in the face of the desires of the person in pain. So, are there other more empathetic ways of elucidating useful information regarding their pain experience? (And avoid flaring-up an easily provoked pain problem)
I recently saw a teenager in my clinic that displayed a ‘protective force field’ over the right side of her body. When she used the Recognise app on a smart phone, she leant even further away from her right side than she already was and held the phone over her left knee with both hands, quickly navigating through the images. We picked up a small deficit in the accuracy for her affected (right) side of 88%, compared with 100% on the left. Here response times were very quick, both at 0.9 seconds.
I asked her to repeat the test on a couple of occasions whilst leaning over her right knee/side of space (i.e. her painful side), which she was happy to do. On these occasions the accuracy remained at 100% on her left side but dropped on the right/affected side to between 75-80%.
Interestingly there was also an accompanying change in her response times for her right side. They slowed to between 1.3-1.6 seconds, whereas her left side remained at 0.9 seconds.
I think this is an important change. There is a reflection here of a processing bias away from her right side (shown in the slowing of times) when performing the test in her right-sided space. There is also a reduction in her online body schema for her right foot whilst performing this in her right-sided space.
I am pretty sure that there are a number of factors that could be considered when interpreting these interesting, empirical observations. What this and previous clinical experiences have taught me is that there are obvious strengths when being a little more creative in our assessments to inform and add further individual, context-based creativity to treatment. It is liberating to know that we don’t have to jump straight into a protective force field in order to gain a better understanding of a person’s pain experience.
What are your thoughts?