Aggressive patient

I was recently on placement where i was chalenged by a confrontational patient. The patient had been in the public hospital outpatient system for many years and had continuing chronic LBP that first arose following a flexion/rotation lifting injury and prior to this there had been no major incident of spinal pain of any description. This middle aged man had been in pain since the incident with the only relief coming from acupuncture and upon subjective he appeared depressed, frustrated and even angry at times regarding his condition. Objcctively, it was clear there was elements of central sensitisation occuring with extreme tenderness to light touch over the erector spinae bilaterally and with slight pressure there was an explosive pain response. The supervisor confirmed my suspicions and thought the best way to treat this gentleman was to manage his condition and not perform any manual treatment. As i entered the cubicle i explained what was occuring and how any treatment could exacerbate his condition whereas managing his condition has been proven to be beneficial in such conditions.
He quickly snapped at me that i haven't done anything and verbalised his disapproval at the course of treatment. It took me a good 10-15min to explain in depth how his condition was not improving and how physio applied before he started to appear to trust what i was saying. Following this the patient came to all alloctaed physio sessions and complied with treatment until i left the placement.

This situation initially surprised me as i was being intimidated by the patient and my decision making was being questioned. Only after an extensive explanation did the patient understand why we were doing the things we were. It made me realise these types of chronic patients often need much more verbal input and support to facilitate their treatment/management then acute/sub-acute patients. I will now hopefully be able to identify these types of patients and give succint xplanations as to why hands on therapy is not always indicated as most patients do expect it.