Male, age sixty-nine. Diagnosis: painful lumbosacral diabetic neuropathy since 2001. Electrical-shock pain down the leg, severe back pain, painful knee and leg, pain spreading to the opposite side, unable to walk without crutches

This patient, a lawyer, had severe pain and hyperesthesia in his right leg, from the groin to the knee. The low back on his right side was constantly and extremely painful, his right leg was becoming weak, and he had to use a crutch to walk. The pain was intolerable and he became severely debilitated.

For many months, this patient was unable to work or socialize, due to pain. He felt that he was unable to perform normally in society and began to retreat; avoiding any activity that he believed was impossible due to the enormity of the pain. Physical movement was difficult, and his voice became tired and weak.

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He commenced physiotherapeutic pain control in October 2002 and was encouraged to continue working. He experienced positive results. “I forced myself to make an effort to work and to interact normally within my family,” he said. He found that the pain became less obtrusive, and he was eventually able to cope with a normal working day and lifestyle. Allowing himself to return to work and becoming involved in active therapy provided a “distraction” that enabled the patient to focus on other activities rather than pain, which, in turn, began to diminish in its importance and effect. He had greatly improved by December 2002, just two months later.

Sympathetic, caring physicians carefully listened to patients and then treated the first group. “Detached” physicians, who merely administered the treatment, treated a control group. The result was not surprising: The first group responded substantially better than the control group, indicating that patients respond best when given the full attention and care of the medical attendant.

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There are a number of requisites in the interaction between patient and therapist that facilitate a positive treatment outcome. “Positive” here means that the effect readily demonstrates improved pain control and/or relief and a sense of achievement. These requisites include the following:

1. Patients are entitled to an explanation about their condition and treatment. This type of communication should continue throughout every interaction between patient and therapist or doctor.
2. The patient should frequently be reassured, because satisfaction and contentment with a therapy is the key factor in promoting a positive outcome.




3. Throughout treatment, therapists and doctors should constantly communicate and demonstrate the progress and improvement achieved by the patient, because “seeing is believing.” When a patient has proof that something has happened (e.g., his or her movements are more flexible), realization dawns that there actually has been some improvement. Often, patients do not believe that any improvement has taken place until some aspect of progress is demonstrated to them. For instance, a knee that was stiff can now move into flexion, or a hand with previously inflexible fingers is now able to close and make a fist.




4. Every patient who succeeds should be praised for his or her achievement. Successfully getting better is the achievement of the patient, not of the therapist. The therapist can offer treatment, but the patient has to go through the motions, repeat the exercises, and make all the necessary effort for progress to be attained.