Pain is real to patient and provider when empathy is present – Sept 2018 – by Beth Hogans
“Of pain you could wish only one thing: that it should stop.
Nothing in the world was so bad as physical pain.
In the face of pain there are no heroes.”
― George Orwell, 1984
Biologically, pain is a sophisticated aspect of sentient corporeal existence: evolved to defend living beings from inadvertent harm, pain results in decreased biological fitness both in excess and deficit.
Foremost, the pain system is a deeply ingrained protective system necessary for flourishing and survival. Those with absent pain perception will experience recurrent wounding and shortened life-spans.
By contrast, those with excessive pain perception suffer harm, their internal experience makes social engagement and productive life impossible.
Severe pain causes ruinous suffering so that healthcare providers must attend to the deeper dimensions of pain, not failing to provide treatments that are timely, safe, and cost-effective.
Because pain is complex and distinguishing ‘superfluous’ pain from ‘sentinel’ pain requires cautious discernment, the clinical challenge of pain is compelling; unfortunately most health professionals receive only minimal formal training in pain management.
For decades, pain has been dismissed by the privileged and pain-free as ‘subjective’ and still today efforts continue to identify the objective measure of pain.
I noticed this too: The subtle arrogance of good health.
Even once visualized on a computer screen however, pain will remain an intensely personal experience. One person can only understand another’s experience by dint of conscientious effort. It is time to dispense with calling pain subjective, it is not; It is intersubjective.
To declare pain ‘subjective’ perpetuates outdated and inhumane misconceptions, reflecting persistent denial of empathy combined with slow diffusion of knowledge.
What is empathy? Listening to others when they tell us about their experiences; with compassion, we respond to alleviate pain.
I recently saw a patient I first met three years ago when she was seeking treatment for intractable severe headaches. The headaches had started during a medical procedure and her symptoms were initially dismissed.
She endured years of pain as doctor after doctor minimized the pain or proposed stop-gap solutions.
Over several meetings, we worked together and developed a comprehensive treatment plan for her headaches, adopting solutions based on her preferences and inclinations. The treatment required a lot of effort on her part and tolerant sensitivity on mine.
We settled on combining
- a low-dose pain-active antidepressant with
- daily transcutaneous electrical nerve stimulation,
- a physical therapy-based home exercise program,
- activity modification, and
- sleep hygiene as well as
- non-opioid rescue medication.
The patient learned a lot about her condition and was now in charge of her pain management.
The critical step on her journey was to find a trained practitioner to listen to her and accept her pain without judgment: someone prepared to learn about her life, her values, her personality, and her pain; ready to explore the options for self-management, and take time to discover what that pain was telling us both.
Author: Dr. Beth B. Hogans, an Associate Professor of Neurology and Director of Pain Education at Johns Hopkins School of Medicine, is interim Associated Director of Education and Evaluation at the Baltimore Veterans Administration Geriatric Research Education and Clinical Center and editor of the Pain Education and Training section of Pain Medicine.