The painting illustrates a daunting pain which is uncared for, and the nail symbolize an internal forces which is provocative and unbearable. The title It Hurts elaborates the theme of the painting, as the nail is forcefully penetrated to cut deeper into the flesh. The person on the painting bled intensively.Other times pain is excruciated to an extent that the lacrimal glands fails to release tears and numbness becomes the cure of the pain. In addition, the anterior spinothalmatic pathways are inhibited due to the increased pain intensity, the spinal cord is capable to block the pain gait of the brain in order to numb the pain thus it becomes an adaptative pain.

The ethical dilemma I experienced in my block placement:

I was instructed to perform treatment on a patient who was diagnosed with miliary TB and TB meningitis. Her past medical history indicated that she had a stroke which has progressed in developing secondary complications, she became aphasic. On the first day, I introduced myself and explained my role as a student physiotherapist. She had recognized my presence and understood the reason I was attending to her, maybe , but her smile disappeared completely the moment I passively stretched her right arm. She let out a loud cry of agony, and she became very resistant. I did not know what to do next, I was panicking because it was my first time to experience such and I had to report back to my clinician. I called a nurse to come and assist me, she refused to come and made unruly remarks that the patient is being difficult , and that is what she is famous for. I could not understand her insinuations, I thoroughly read her file again with a pursuit of finding whether her level of consciousness is not impaired. Apparently, it was due to the TB meningitis and the spasticity has progressed as she was diagnosed with a stroke a year ago without receiving a physiotherapy session to normalize her tonicity. I understood immediately why she was being potraited as being ‘difficult’, the person is in pain and it is normal to protect the site of pain. She is unable to speak, and crying is the only form of communication she is able to use in order to express her feelings, in this case she felt pain and she cried to show that she does not want to continue to feel miserable. I could not continue with the session, it was unbearable to hear to someone crying and the worst is you being the cause. I know this would sound unprofessional but pain is what make people fragile and strong at the same time, nevertheless empathy is important in order to sustain a relationship between the two parties a physio-patient relationship. The physiotherapy session with the patient would be ineffective, as some exercises requires the patient to actively perform them and she is unable to. With repetition is how the brain relearns motor control, by enhancing neuroplasicity, however it is unfortunate that the patient will not recall any of the exercises demonstrated to her due her mental disorientation, and the pain is worsening each day.

In my own perspective the patient was actually in pain due to stroke and her rights were infringed because she kept on expressing her emotions through crying . Her muscles were very spastic on the affected side and that might have intrigued her pain, and the pain is a symptom central post-stroke pain.

Central post-stroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident.
This syndrome is characterised by pain and sensory abnormalities in the body parts that correspond to the brain territory that has been injured by the cerebrovascular lesion(Klit, Finnerup & Jensen, 2009). The presence of sensory loss and signs of
hypersensitivity in the painful area in patients with CPSP might indicate the dual combination of deaf erentation
and the subsequent development of neuronal hyperexcitability (Klit, Finnerup & Jensen, 2009).

Reference

Klit, H., Finnerup, N., & Jensen, T. (2009). Central post-stroke pain: clinical characteristics, pathophysiology, and management. The Lancet Neurology, 8(9), 857-868. doi: 10.1016/s1474-4422(09)70176-0