Home' Trinidad and Tobago Guardian : October 16th 2015 Contents noses of stress-related pain much at all...at least in
physical therapy. Usually, patients in chronic pain
related to stress go through all the medical diagnostic
tests, which they should, in order to rule out certain
issues. They have MRI s, X-rays, CT Scans, etc, and
are usually diagnosed based on the results of these
tests, despite the fact that their symptoms may not
match the test results. Treatment then ensues for
such diagnoses, but the patient seldom improves
because the stress is not targeted as a cause.
Pain, and its lack of improvement can cause a
vicious cycle that leads to further stress and per-
petuation of pain. It is a difficult cycle to break---
pain leads to the patient becoming more timid and
fearful of movement. This fear can be made worse
by lectures and diatribes from healthcare providers
and family, telling the patient to "take it easy." This
causes what we call "fear-avoidance" of activities
and the patient becomes unnecessarily limited in
his daily and leisure activities. Fear avoidance is a
common occurrence in many people with pain. The
limitations in movement from avoiding activities
lead to deconditioning and muscle weakness, which
can then make pain worse. The cycle continues with
more fear, more avoidance, more deconditioning.
and more pain. In severe cases social isolation, depres-
sion and anxiety ensue.
Often, it is only when all medical treatment has
failed, that healthcare professionals begin to consider
psychological stresses as significant contributors to
pain. By then, the patient is so far into the pain cycle,
that significant psychological intervention is necessary.
Yet, many patients are reluctant to see a psychologist,
despite education on the need for such interven-
Breaking this cycle involves a team of healthcare
professionals. A one-man show is sure to fail in a
case of stress-related pain. Effective treatment begins
with the physician, who the patient initially seeks
out because of the presence of this pain. He/she
performs all the relevant medical tests to rule in/out
certain causes for the pain. Early flagging of certain
signs and symptoms of stress and anxiety/depression
is key to getting the correct professionals involved
as early as possible. Once this is done and the physi-
cian determines the contributors to the pain, he/she
can then refer to these professionals.
They can and should include a psychologist to
help with managing the stress-related issues, and
developing coping mechanisms to deal with pain. A
physical therapist is also a vital member of this team
and will work with the patient on pain management,
on reinforcing the coping techniques learned from
the psychologist, on increasing his/her strength and
endurance, and will take the patient through graded
exposure to activity so that the patient can overcome
fear of movement and re-integrate into her/his regular
activities of daily living and leisure. Occupational
therapists may be necessary team members as they
can work with the patient on home and activity
modification that can make activities easier, which
will assist with increasing the confidence and inde-
pendence of the patient. Other healthcare profes-
sionals who offer appropriate pain management
techniques may also be involved.
As scientist Hans Selye once said, "It s not stress
that kills us, it s our reaction to it." We all have
different ways of dealing with stress. But when it
begins to affect us by causing pain, it s time to make
some changes and get the right professionals to help.
• Carla Rauseo, DPT, CSCS, ATRIC is a Doctor of
Physical Therapy and a Certified Aquatic Therapy
Rehabilitation Instructor at Total Rehabilitation
Centre in San Juan. http://www.totalrehabtt.com
Friday, October 16, 2015 www.guardian.co.tt Guardian
Invitation to Bid
SUPPLY OF JANITORIAL SERVICES AT NP COMPOUND - SEA LOTS
Trinidad & Tobago National Petroleum Marketing Company Limited invites suitably qualified suppliers/
contractors to bid for the Supply of Janitorial Services at NP Compound, Sea Lots, Port-of-Spain.
NP proposes to contract for the supply of Janitorial Services at its Sea Lots compound facilities inclusive of
offices, toilet and bath facilities, recreational area, lunch and change rooms, and work stations.
COLLECTION OF BID DOCUMENTS
Contractors wishing to respond may obtain the Invitation to Bid Documents from Monday 05 October, 2015,
to Friday 16 October, 2015 after the payment of a non-refundable fee of TT $600.00 by Cash, Certified
Cheque or LINX to the Head Office Cashier at NP House, National Drive, Sea Lots, Port-of-Spain between the
hours 7:30 a.m. to 11.45 a.m. and 12.45 p.m. to 2.30 p.m.
Bid documents may be collected upon presentation of the Receipt at the:
Contracts Administration Department
Trinidad & Tobago National Petroleum Marketing Company Limited
NP House, National Drive, Sea Lots, Port-of-Spain,
SUBMISSION AND CLOSING OF BIDS
The original and a copy of each Bid shall be submitted in a plain brown envelope clearly marked:
"SUPPLY OF JANITORIAL SERVICES AT NP COMPOUND, SEA LOTS."
and addressed to:
Trinidad & Tobago National Petroleum Marketing Company Limited
NP House, National Drive
and deposited in the White Tenders Box, located in the Phase III Lobby at the above address no later
than 10:00 a.m. on Wednesday 18 November, 2015.
Bids must be accompanied where applicable by:
i. Income Tax and Value Added Tax Clearance Certificates issued by the Board of Inland Revenue and dated
not more than six (6) months prior to the closing date of the Tender.
ii. Valid Certificate of Compliance issued in accordance with the National Insurance Act, Chapter 32:01.
iii. A copy of your receipt for the payment of TT$600.00 for the bid documents
A Public Opening will be held immediately after the tender closes, at NP House, National Drive, Sea Lots,
Port-of-Spain. All bidders are invited to attend.
Bids received after the closing date will not be considered.
Trinidad & Tobago National Petroleum Marketing Company Limited reserves
the right to accept or reject any or all bids or annul the bid process at any
time or cancel any or all of the works and services for which the Invitation to
Bid is issued in its entirety or partially without defraying any costs incurred
by the bidder in its participation in any part of the bidding process including
but not limited to the preparation and submission of bids.
It is generally accepted that emotional
or psychological stress can make one s
physical pain worse, but there is now a
new concept of "stress-related pain" that
takes this idea even further. It assumes
that the patient s psychological and emo-
tional factors are the primary cause of the
patient s pain. The fact that there is an
actual diagnosis of stress-related pain
speaks to the remarkable role stress can
play in pain.
The purpose of this article is not to focus
on stress-related pain as a diagnosis. Rather,
I would like to discuss how stress can present
itself in a physical way. I am not a psychol-
ogist, but in my practice I do see the man-
ifestations of stress in the body and it is
my job to identify them and offer proper
referrals to the relevant qualified profes-
sionals, with the approval of the physician.
There are a number of theories that
attempt to explain why stress can cause or
perpetuate pain. The common thread in all
of these theories is that psychological and
emotional stress cause some type of physical
change in the body, resulting in pain. It is
important to note that it is unfair to brush
off a person s pain as "all in his head." The
pain is real.
In Trinidad, we do not see official diag-
Stress can perpetuate pain
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