Natural history and common misconceptions: Treatment with education and empathy

Abstract

Enthesopathy of the origin of the extensor carpi radialis brevis (eECRB) feels like damage, the associated pain feels like interference with healing, and it feels as if something needs to be done or it will hurt forever. However, best evidence suggests that eECRB is a common, benign, self-limited rite of passage through middle-age that lasts about a year or so and for which we have no disease-modifying treatments. That is difficult for patients and caregivers to believe. Curiosity—an enthusiasm for thinking past one’s first impressions—seems key to minimizing symptoms and disability in diseases like eECRB. Patients can learn self-efficacy (confidence they can reach their goals in spite of symptoms) and caregivers can either reinforce or undermine this effective coping strategy by what they do and say. Given that self-efficacy is—by far—the strongest predictor of pain intensity and magnitude of disability, caregivers should try to optimize it with all they say and do for each patient.