Pain is what the person says it is

Pain is probably one of the most universal human experiences. But that’s also exactly the problem; you may be able to imagine the pain of a loved one, but you have absolutely no way of knowing exactly how that person feels. We are each entirely alone in our pain; it’s just impossible to know whether the sensations you feel are the same as that of anyone else.

Another problem is that pain isn’t visible. We can see the signs of pain, wincing, grimacing, and protecting the painful area, but what if someone is skilled at concealing their pain? Most of the time I work hard to hide my pain from others, plastering on a smile and replying that “I’m fine!” to any questions about how I’m doing. The reality is that I’m always in pain since a few years: I’ve completely forgotten what it feels like to lead a pain-free life.

We’re also incredibly ill-equipped to describe our pain in words. Our language just can’t do it that well so we end up reaching for metaphors and simile to help us out:-)

I believe that doctors, nurses, and other professionals who can listen to people’s stories and show genuine curiosity about them become more effective healers and can produce better medical outcomes also when it comes to pain.

Conference

Last weekend the Multidisciplinary Pain Management Conference was held virtual.

Copied from the website:

You’re a culturally-competent active listener who knows how to explain pain, so why doesn’t your patient get what you’re saying? Why can’t they accurately describe their pain experience, and what do they really mean when they give you a pain score? Effective communication is key to a successful therapeutic alliance, yet misunderstandings abound. 

This engaging presentation from an individual living with persistent pain examines the difference between what clinicians say and what a patient may hear.

Explore the language of lived experience and learn how the words you use affect adherence and outcomes from a patient point of view.

I love to share the presentation by Kat Gloor at the 2020 SD Virtual Pain Summit.

https://www.sandiegopainsummit.com/patient-perspective

In-depth questions

In her presentation, Kat shows a slide with questions you can ask.

Proposed “in-depth” questions for people in pain. I removed the question ‘Why are you still in pain?,’ because most of the time people don’t know why they are still in pain.
● What do you think is going on with your [fill in area they are seeking help
for]?
● What do you think should be done for your [fill in area they are seeking
help for]?
● What would it take for you to get better?
● Where do you see yourself in 3 years in regard to [fill in area they are
seeking help for]?
● What have you found to be most helpful for your [fill in area they are
seeking help for]?
● You have obviously seen many people seeking help. What are your
thoughts on this?
● What gives you hope?
● What is your expectation of PT?
● If I could flip a switch and remove all your pain, what things that you
have given up on would you do again?
● How has your pain impacted your family and friends?
● Are you angry at anyone about your [fill in area they are seeking help
for]? Tell me about it.
● Has anyone made you feel like you’re “just making it up” or “it’s in your
head?” Tell me about it.

Ina Diener PT, PhD, Mark Kargela PT, DPT, OCS, FAAOMPT & Adriaan Louw
PT, PhD (2016): Listening is therapy: Patient interviewing from a pain science perspective,
Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2016.1194648