I don’t expect I’ll ever live without pain, but I need to find ways to live a happy life.
As an avid outdoor athlete, Ida had skied, hiked and been a passionate swimmer for most of her life. Though trained as a tailor, at the time of the accident she was employed as cashier at a swimming center. At the age of 54 she had a major ski accident, that left her with a severe polytraumathat included a list of complex injuries:
- Sensomotoric complete paraplegia sub Th 4, (ASIA A) through a dislocation fracture (Th 4-5)
- Autonomous dysregulation with impairment of bladder, bowel and sexual functions;
- Craniocerebral trauma, sub-arachnoid hemorrhage, fracture of osteophytes, fracture of the skull;
- Rib fractures (1,4-7 dorsal), fracture of the sternum, hemato-mediastinum and a hemo-thorax;
Her first rehabilitation began three days following the accident. After three months with a normal course of rehabilitation and with no pain problems, neuropathic pain suddenly developed, appearing literally from one day to the next. The pain was a constant burning and shooting and Ida’s legs felt as if they had been moulded in concrete. Over the subsequent months, Ida was treated for pain with medication and acupuncture, however none of the pain management interventions offered much improvement and Ida’s pain continued to impact and reduce her quality of life significantly. Nine months after admission, she was discharged from first rehabilitation although pain has become a chronic impairment.
Seven months after discharge of her first rehabilitation (16 months after accident), Ida was again admitted to a rehabilitation center for her first pain therapy because the pain again worsened. She stayed for a month in the clinic, being prescribed new medication. Although non-pharmacological interventions like sports were added to her pain program it was not a comprehensive approach to her problem but was focused on finding the right drug.
At discharge, Isa felt better and was optimistic that the pharmacological changes that have been made might would help her dealing with the pain. However, this proved to be wrong and nine months later (25 months after accident) Ida was admitted again for treatment of pain, all without long term success. Her third pain therapy followed then four months later (29 months after accident) but lasted only three weeks.
Only five months passed until she was admitted to the clinic again. On new year’s eve, almost two years after her first rehabilitation (32 months after accident) Ida started her fourth pain management program because the pain constantly returned and made it impossible for her not only to participate in her social life but that affected her in her daily routines and even prevented her from sleeping and eating.
This time however a comprehensive and interdisciplinary approach to managing her pain should be undertaken over the course of eight weeks. The overarching aim was to improve Ida’s quality of life and in particular to increase her participation by reducing chronic pain. The focus should be on the improvement of physical functioning, addressing psychological needs and empowering her family and network to support her in improving her participation and social functioning.