Case of the Month #30: Pain and Hypermobility

The pain management team formulated a plan, together with the patient. She was aware of her diagnosis, provided by her rheumatologist and the team explained the next steps, which would include some further sessions with the pain services’ specialist physiotherapist. These sessions initially focussed on helping her develop an understanding of complex pain and supporting her to develop some skills to manage her own pain in the long term. She acknowledged she struggled with pacing of activity; she was used to pushing though her pain to achieve a task. She found this particularly difficult to change and she explained she had always fought to maintain high standards, whether it be in her work, around the home or in her role as a mother. She acknowledged she consistently suffered with increased levels of pain at the end of the day and things were worse after a particularly intense period at work, when she took on additional roles to cover for colleagues. 

The specialist physiotherapist presented her case at the team’s weekly case discussion meeting and the group agreed on a plan to offer the patient a series of combined sessions with the physiotherapist and clinical psychologist in the pain service. Miss L agreed and engaged well with the sessions, working towards her pacing goals to prevent flare ups of pain after activity. After the six sessions were completed, she agreed she had made significant progress and was now able to put her own health first, taking time for herself and becoming less focussed on getting a task done despite her inevitable increase in pain. She found this approach prevented flare ups and struggles at the end of her day. The team indicated that she may benefit from attending the pain services’ pain management programme in the future, but Miss L agreed that she was currently doing well and required no further input from the team at present.