My patient had chronic foot pain (“severe multi-joint degenerative changes” on scans) and over a decade of swelling – she was improving really well with therapy aimed at foot health, foot in the brain representational health and interactions between the two. In particular, the swelling was easing, allowing better movement.
I mentioned that slight pain and swelling increases (I don’t like the word ‘flare-ups’) would probably occur along the recovery journey. This was nothing to worry about and it was related to the fact that after a decade her brain thought it was now normal to have a swollen foot and that it would try and readjust and keep it swollen. This is particularly so, as the brain had thought for so long that swelling was a good way to keep the foot protected and to heal it. I said that changes in pains and swelling were good things as it meant she still had the power to change. New pain are usually good pains (in this situation).
She looked at me for a bit and then the response “… so my foot still thinks it’s a bit thirsty and it demands fluid to help it heal, but it doesn’t really need it, does it? My brain has been sucked in for a long time.” My story had been summed up in a few seconds.
I think I will steal the phrase, “that hand/foot etc. doesn’t need to be so thirsty” for others with persistent swelling. I hadn’t realised that ‘thirsty’ could be such an evocative word.