October 2026

What's Still Missing After the Fracture Heals

An X-ray can show a fracture is healed and still miss the reason a client can't sleep, work, or get through a day without pain.

In a recent case I reviewed, the client had persistent, daily, disruptive pain after a fracture. By the time I became involved, the medical record already included treatment directed at the structural injury. But his pain had become more than a tissue-healing issue. It was affecting function, sleep, activity, and his ability to move through everyday life. He had not yet received Cognitive Behavioral Therapy (CBT) for chronic pain.

I included CBT in the future care and cost projection because it is a first-line, evidence-based treatment for chronic pain. This is not about suggesting the pain is imagined or "all in the mind." CBT addresses the pain cycle: fear, distress, disrupted sleep, avoidance, and the heightened attention to pain that can keep the nervous system on alert long after the fracture itself has healed.

A steroid injection may be appropriate in some cases. But it is not a complete plan for every person whose pain has become persistent and life-limiting.

Future care should reflect the whole clinical picture, including treatments a client reasonably needs but has not yet received. CBT can improve pain-related distress and function and is commonly recommended alongside physical and medical care for chronic pain.

If a case on your desk has pain that has outlasted the injury on paper, I am happy to talk through what the future care picture should include.