Pain Education: Are You Doing It Right?
Have you ever felt unsure about your ability to teach someone about PAIN? Or wondered if your attempts actually helped them understand and better manage it?
I remember when I first started. I muddied my way through explanations of nocioception, trying not to use formal science words but unsure what to replace them with. I wanted to deliver the message of No Brain, No Pain but also feared I was creating a nocebic identity of “It’s all in my head.”
I was awkward. Dubious of my delivery and likely having the same effect on my patients. But I kept at it, self-reflecting and experimenting with each encounter. Through this process I now have way more wins than failures. At least I think I do.
Which brings up the point of this post: How do you know if the information you’ve delivered has had a positive impact?
I love the old adage “One size does not fit all” But I also appreciate that in heath and wellness, as well as education, there are times when “One size fits most”
When it comes to Pain Education, doing it “right” involves several key factors:
1. The tone of delivery is positive and simple
2. The stated goal is the individual’s empowerment
3. Metaphors are used to help explain principles
4. Detailed Neuroscience and anatomy is avoided
5. Concepts are reinforced in subsequent visits
And the last and often most important key to long term success:
6. Make the information relatable to their life so they can take the reigns and apply it.
The following are examples of my patients who took their new knowledge and applied the information to their experiences.
The power of language is self evident with pain education. Common sense and plenty of legit sources will tell you to use your patient’s words. This is important as it helps to acknowledge and validate their experience.
Equally as important is how you talk about symptoms. Words like nocioception or central sensitization likely confuse and intimidate more patients than they elucidate.
By using simple alternatives to pain like discomfort or tightness (tension) we may change the meaning of the experience. This can be done in a way that is validating. For example, discussing how someone might continue to experience discomfort as they balance the stress of loading a post-surgical limb.
This happened with one of my patients recently. Having had many years of persistent pain he was starting to feel better. This of course made him want to do more in therapy and his daily life. I encouraged this while also citing that a normal expectation with increased activity would be "some DISCOMFORT or FEELS."
He latched onto the word FEELS.
As we continue to expose him to more stress there are times when he has PAIN and times when he has FEELS. Having the ability to categorize his sensations differently helps him realize that not all sensations warrant a heightened reaction and that some discomfort is a part of life.
For more on this check out this guest post I did for Zac Cupples.
Self-reflection on teaching pearls will demonstrate that the individual you are helping has personalized the concepts.
Sometimes I like to use the strategy of DIMS and SIMS to expose patients to the multifactorial nature of pain.
This structure helps patients understand that something as seemingly unrelated as insomnia or the recollection of a past memory can influence their present symptoms.
How do I know if this concept is working? When patients start to tell me about either flareups or improved symptoms and can relate them back to their individual contexts, their DIMS or SIMS.
While this has certainly been a year for increased stress for many, it has also been a year where several patients are readily connecting their symptoms to stressors outside of their bodies. Some examples have included politics, social isolation or fear of their future in many forms.
When someone can identify that their symptoms are related to factors outside of their body, they also realize that part of the solution is how they conceptualize and deal with these stressors. They can start to problem solve.
METAPHORS BECOME PERSONAL
When you witness the personalization of metaphors you know that your patients are starting to understand the experience of pain on a new level. This often happens in the context of a metaphor that you have already used but sometimes they write their own.
One of my current patients has made incredible progress after years of persistent pain.
Despite having read the book ‘Explain Pain’ at the recommendation of another practitioner, the knowledge she learned had not become hers. There was less of a meaning effect. Our approach has been less formal and more personal.
Last week I asked her a simple question.
“What does pain mean to you?”
“Pain is an unpleasant sensation that feels like something in my body is trying to get my attention. It’s like when someone rings the doorbell to my house.
I’m learning when I want to pay attention and answer the door because it might be important. But it might not. When I peak out the window and see it’s just a solicitor, I realize I can focus my attention elsewhere.”
Previous analogies for understanding concepts were helpful but generating her own further influences ownership of her present and future experiences.
You can go ahead and steal that doorbell analogy. I plan on using it!
You know you have helped a patient or client better understand the intricacies of pain when they have taken ownership of this new knowledge and applied it in some way.
1. The Power of Language is indisputable but has their language changed?
2. Self-reflection on the multiple contributors to the pain experience can empower patients in many ways especially by spotlighting the things they can change.
3. Personalized metaphors demonstrate their story about pain and it's meaning is starting to change.
Just as you strive to increase movement options you can also expand a patient’s word choices to describe their symptoms, provide tools to apply the new information and metaphors to relate to. More options may provide them with a different perception and improved experience.
You guide and they will follow.
Photo credits: Brett Jordan, Natalie Parham, the blowup from Unsplash