The following Do's and Don'ts should be followed.
Do remember that chronic pain = TPs
Since muscles are associated (touching) everything in the body except the brain, spinal cord and inside of bones they are affected by almost any condition. They can develop TPs. Once the initial condition is resolved the TPs can remain and cause chronic pain. Generally expect to find TPs in 99% of chronic pain cases.
DO NOT - hold pressure longer than 60 seconds
Even in the longest chronic severe fibromyalgia patients it should not take longer than 60 seconds to create a change for the better if it's a TP. Sometimes it may get worse for a short time before it gets better. Ask the patient to bear with it at a tolerable level of pain until the test period is done. IF IT DOESN'T CHANGE GET OFF IT! IT'S NOT A TRIGGER POINT!
DO NOT - apply more pressure just to make pain
The firm pressure should be to either a level of pressure that patients feel as firm pressure and that most patients would not describe as painful or at a level of pressure that the patient feels an abnormal pain or discomfort as soon as pressure is applied - whichever is less.
DO - advise the patient what to feel PRIOR TO TESTING
Tell the patient IN ADVANCE that you can't feel the pain, that they have to let you know when a TP is found and that it will change for the better within 60 seconds - usually 15 to 20 in most cases.
DO - have the patient monitor the change in pain
Describe the change as from sharp to dull, spread out to focused on one spot, or intense to less intense. Warn them that sometimes it may get a little worse before it gets better. Make sure they understand the pain will not go away - it will just change.
DO - pre- and post- ROM with the patient to validate immediate results to the patient
By doing pre- and post- tests it will impress the patient of the change. Without the Pre- test the patient has no reference to see a change for the better.
DO - advise the patient of post treatment expectations
Tell the patient it will feel better for awhile after you've finished treatment but that you don't know how long it will feel better - 15 minutes to the rest of the day before the pain begins to return, not until it gets bad. However, you need that information to know how severe and serious the TPs are. It will tell you whether the patient will be at the shorter or longer end of your treatment plan time period. Warn them that on rare occasions some patients experience worse pain after the pain begins to return. These are normal recovery symptoms you will deal with and correct that. When the patient returns focus them onto how your treatment made them feel better for however long as a very positive patient management tool.
DO - look for further TPs as the active TPs dissipate
When a patient begins to get better they will describe how the pain is moving to somewhere else. Explain that the first place hurt more than the second. That's why they didn't recognize the second place earlier. Now as the first is getting better you can change to work on the second place now. By working on successive TP regions you do better work for the patient, increase patient retention and end up making more money.
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