From our good friend Blanaid Coveney:
Buying some time
Most people know how hard it is to explain pain to patients especially … well … when they have ongoing pain! The endless touring of different clinicians and specialist clinics in pursuit of a cure is common. Ingrained belief systems mean that hunting for the source of the pain is often a driving force. Explaining pain can be tricky and from time to time can lead to a patient heading for the hills never to be seen again. You can nearly see yourself losing them in slow motion. Anything which makes it easier to explain pain is always welcome. On occasion you may come up with something which resonates with the patient and buys you time so you can gradually introduce new concepts which may challenge/change the patient’s belief systems.
The other day, one happened by chance. A patient and I were chatting. He has ongoing pain. I can never say the word chronic to the patient. It seems like the ultimate nocebo. Did anything good ever get paired with the word chronic? Did you even hear of chronic success or chronic romance or being a chronic winner? No! Seemingly endlessly negative things are paired with the word “chronic” like anxiety, debt or disease. So, ongoing pain it is.
Finding a metaphor
Anyway, over time, this patient’s pain was being triggered by less and less stimulus. Naturally he felt that this meant his disc disease was worsening. As we were chatting, something came to me which was surprisingly useful. I asked him whether he had a burglar alarm at home. Having confirmed he did indeed have an alarm, we spoke about the merits of a good burglar alarm, principally the safety in knowing your valuables are protected and your personal safety is assured. Obviously you want the alarm to go off when you are being burgled … but what if the alarm is so finely tuned that it goes off when it is windy or if there is thunder and lightning or when Man United are beaten ? Then, its a pure nuisance and of no benefit to you.
Explaining that his brain was continuously evaluating the threat level and was a little too sensitive was a surprise to him. Comparing his brain’s current response to the perceived threat level with a too-finely tuned burglar alarm really hit home. Finding ways of reducing the sensitivity of the alarm in a wide variety of ways now seems to make sense to him . Sometimes you get it right. So often you don’t. There is a long way to go but perhaps changing things one patient at a time is not too bad.
Blanaid Coveney is a practicing physiotherapist in Dublin, Ireland. Her professional interests are around epidemiology, pain and all things brain related.