Pain...  What are your thoughts on pain?

You are treating a 55 year old female patient who has back pain.  Onset date was 12 weeks ago.  Insidious onset - woke up with back pain.  Patient has not had any symptoms of pain past the buttock region.  No red flags are present.  Standing, bending and twisting were reported to be difficult and tend to increase symptoms of pain.  Oswestry Disability Index score is 35%.  The Fear Avoidance Beliefs Questionnaire indicated a score of 16 on the physical activity section and 34 on the work section.

When this patient reports pain during an activity you are asking her to perform, what goes on in your head?  What do you think?

a)  Stop!  Don't be doing that!  Pain is a bad thing.  Pain is harmful.

b)  Whoa... What's going on here?  Really?  There is pain?  Nah, there can't be pain with that.   Hmmm... I think I'll just wait and see what happens.

c)  NaNaNaNaNa... I don't hear that.  It doesn't matter because nothing bad should be happening right now.  What am I supposed to do about it?  I'm just going to ignore that comment.

d)  Hmm, I don't know what the patient means by "pain."  I think I need more information to better understand what the patient is telling me.

e)  Hello?!?! Yeah, you should have pain.  Geesh, that's what you're here for!  I mean, are you dense or what?  PT stands for "pain and toruture."  Do you think it's just magically going to go away overnight?

f)  Glad I don't feel her pain.

My curiosity about your thoughts was sparked after Michael Boyle posted his thoughts about pain and exercise "Does it Hurt?" on his blog "The World's Best Source of Performance Enhancement Information."  

For this patient and for the information provided about this patient, what would your initial thoughts be when she reported pain doing an activity you are suggesting?  I gave a few examples of what you might initially think.  You may have a different thoughts.  I'm curious... share!

~Snippets