Do you provide therapy when patients are in pain? | Reader Question


I receive emails from many of you frequently, and you ask some really great questions. So with permission, I will share an email I received and my response. Please weigh in. How do you manage patient pain?

What do you do if patients are in pain?

Hi Rachel,

I have an ethics question for you. When a patient you’re evaluating is in a great deal of pain, at what point do you discontinue testing? Let’s say a brain injury survivor has a migraine. How do you determine if it’s appropriate to continue testing at that time? What about chronic pain, how do you determine when and what is appropriate?

Looking for a little guidance about best practices.

Thank you!


Put first things first.

Dear Sandra,

When someone is in a great deal of pain, I take the opportunity to show that I have their best interests at heart. We all want to be heard and respected. I help them resolve the pain – whether that be adjusting lights for someone with a migraine, helping someone with communication difficulties communicate about their pain, or tell the nurse they would like medication.

Then I ask, ‘Would it be okay if I came back and checked on you in an hour to see if things have improved?’. When I go back and check with them and things are improving then I ask about scheduling the evaluation with them. First things first. I know from my personal experience with extensive pain, patients aren’t able to really participate in the evaluation process when they are in a great deal of pain. In order to do the best evaluation, we need them to participate as much as possible.

In terms of chronic pain, I work with the patient to figure out the best time (based on time of day or when they have had pain medication) to do therapy. I also work with the interdisciplinary team to make a plan for how we will manage the pain and who will provide various types of education to help the patient manage the pain (e.g. breathing, stretching, use of hot/cold packs). I also make sure I understand how each patient experiences pain. Does distraction (e.g. SLP treatment tasks) help them or frustrate them while they are in pain? Some patients welcome the distraction when pain is bothering them. Others find it very disrespectful.

I hope that helps.


Rachel Wynn
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Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
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  • Heather

    Great post! When it comes to chronic pain, I would also add that a referral to psychology is always appropriate: “Psychological treatments are also an important part of pain management.
    Understanding and managing the thoughts, emotions and behaviors that
    accompany the discomfort can help you cope more effectively with your
    pain — and can actually reduce the intensity of your pain.”

    • Rachel Wynn

      Heather – Excellent point! Chronic pain is something I discuss with the team including nursing, social work, psychology, and PT/OT. We all have a role in helping patients manage chronic pain.

  • Alycia Rivet

    Interesting! Glad I read this.