Medical science, and by extension the broader community, has slowly but surely come along way in understanding and treating pain. As recently as just 20 years ago, there was still a widely purported belief that babies did not feel pain, that those in pain without something we could see on a scan or MRI were psychologically unwell, and that there surely will one day be a silver bullet that will allow us to wipe pain out entirely. What hard earned learnings have since shown us is that pain is a complex phenomenon, that it occurs in our nervous system and has far reaching effects across a number of our body’s other systems, that damage to tissues and structures of the body don’t always equate to pain, and conversely that you don’t need to have damage to experience physical pain. Despite all this, the revolution can’t roll out quick enough in a sector where wholesale change is hard to instigate. One thing, however, that we can all do to improve the way we manage pain is by considering a change in the way we talk about pain.
We generally talk about pain by asking sufferers how ‘bad’ it is, as if bad is the objective standard by which we measure pain. The reality is that, because pain is such a complex experience, we need to have a more ‘sophisticated’ way to talk about pain. Moreover, we know that when people have a better way to communicate their experience with pain we have a greater likelihood of applying more effective interventions. So how do we as a community need to break down this experience if we are truly going to understand the way pain affects those who suffer with it? Three domains we should consider are the notions of intensity, bothersomeness and interference.
We usually seek to appraise pain experience around intensity, and accordingly we equate coping with intensity as toughness. Pain intensity is important, it’s usually the aspect of the pain experience that we see the visual effects of suffering. Yet pain does not have to only be intense to have a significant impact on our lives. Not always unrelated to intensity, but distinct from it is the notion of ‘bothersomeness’ – that is, the consideration of how pain bothers or interrupts the person with pain’s conscious experience of everyday life. One can have low intensity pain that is constant and at the forefront of someone’s attention, a constant reminder of the original pain experience, trauma or of the consequent suffering experienced as a result, and this is no less important than pain that is intense.
And what about the most costly aspect of pain, how pain interferes with our daily lives? This is where the cost of pain on our society is so profound. We make a mistake to construe intensity as the only thing that matters in pain that is considered disabling. When we talk about pain in regards to the interference it causes to our everyday lives, we can be talking about pain that only appears in our awareness during certain tasks. More than this, we also need to consider that the learned experience of those with pain to avoid activities that they expect will cause them pain or an increase in the pain experience is just as valid an interference.
As a clinician who has looked after people in pain of all persuasions for many years now, we in healthcare need to do better in helping those with pain to better understand their pain experience, and we can only do this by better understanding the pain stories of those who present to us for help. And as a broader community we can only do better by those who we share life with by giving those with pain our compassion and our best efforts in understanding, rather than the dismissive and avoidant attitudes that have stubbornly persisted for so long.