Chronic Pain and the Patient/Provider Conversation

One of the things to keep in mind about good communication is really being in the room with your patient--really listening. I know that can be quite difficult for some specialties these days especially with mandated reporting on computers and such, but it is so important especially for teenagers to make them feel heard, if you want them to listen to your recommendations.

Another thing is how you deal with catastrophizing. And so if a patient says, “Oh, my goodness! I felt like I was going to die when I had that pain episode,” don’t just automatically assume “Oh, that was an over-exaggeration. Let’s just move on.” Take the time to really understand why the person was saying that and understand where they’re coming from. Your patient is more likely to be able to follow your recommendations if they feel heard and understood. Another component that often is missed is for practitioners to take care of themselves. Working with pain patients is a very difficult thing, so making sure to do your own breathing before each session and taking care of yourself so that you’re able to model that when you’re conversing with patients.

There are a few “just don’ts, as I call them, in the realm of communications. So anything related to, “Oh, you look so good. You’re so youthful. You don’t look like anything is wrong with you. I can’t believe you’re in pain. You’re so young.” Particularly with younger patients, you’ll feed the stigma of invisible disabilities. I myself have chronic pain and spinal injury and several disabilities, and from looking at me, no one can tell, and I have experienced several of those comments myself and it’s quite invalidating. Another one that’s often missed, and many chronic pain patients talk about is the question, “How are you?” That is something in the chronic pain world that is so difficult to answer because the person has to decide: Do I really say how I’m doing? Do I just say ‘okay’ and ‘fine’ because that’s what is expected of me? Or do I make up some other lie about it? The better question to ask, as a healthcare provider is, “How have you been since the last time we’ve seen each other?” Or “What things have you been doing to take care of yourself?”

This topic is near and dear to my heart not only because I’m a pain patient and I’ve had several of these experiences, but because it just reminds us that we’re human. It’s about recognizing our mistakes and then learning from that. It’s not necessarily we have to be on tiptoes around our patients – that’s not it. It’s about really facilitating genuine communication and understanding what are the needs of my pain patients and how can we connect in a way that benefits them on a biopsychosocial and spiritual level as well.