Treating pain is difficult for several reasons. Narcotic painkillers bring with them addiction and other problems, but the medical system isn’t set up to handle behavioral interventions that can help pain management, as I wrote a couple of years ago in a post on “A Behavioral Approach to Treating Chronic Pain and Medical Problems.”
Another reason brought out by Joanna Bourke in her July 13, 2014, New York Times Sunday Review column “How to Talk About Pain,” is simply how difficult it can be to put pain into words that other people can hear. Partly, Bourke writes, this is due to the introduction of effective anesthetics and analgesics, which paradoxically turned describing into complaining:
In earlier periods, doctors regarded pain stories as crucial in enabling them to make an accurate diagnosis. But within a century, clinical attitudes had radically changed. Elaborate pain narratives became shameful, indicative of malingering, “bad patients.”
How are patients encouraged to describe pain today? Often, it’s by picking a number on a scale—sometimes according to a series of increasingly distressed-looking cartoon faces. This might be enough for emergency use, but there’s more to the experience of a chronic pain patient beyond “6. Hurts even more.”
A study published in Proceedings (Baylor University. Medical Center) underscores these findings: “Acute and chronic pain not properly assessed can result in inadequate pain management outcomes and can negatively affect the physical, emotional, and psychosocial well-being of patients. Pain assessment is the cornerstone to optimal pain management.”
For Bourke, assessing pain means listening to the patient:
Pain will always be with us, and by listening closely to the stories patients tell us about their pain, we can gain hints about the nature of their suffering and the best way we can provide succor. This is why the clinical sciences need disciplines like history and the medical humanities. By learning how people in the past coped with painful ailments, we can find new ways of living with and through pain.
Fanny Burney (1752-1840), the English novelist and diarist, wrote a searing account of her breast-cancer operation—sans anesthetic—in 1811. Reading it with a sense of history should give any clinician a better sense of the nature of suffering.
I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound – but when again I felt the instrument – describing a curve – cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator, who was forced to change from the right to the left – then, indeed, I thought I must have expired. (The Oxford Book of Letters, 1995, p. 203)
Modern medicine has impoverished the language we use to describe our suffering.
couples counseling, and Mindfulness-based therapies in the San Francisco Bay Area for over 20 years.
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