A brief ponder

Complete opinion today…!
I’m pondering why we as clinicians can be so scared about increasing our patient’s pain levels. And why patients are so fearful of increases in pain.

I spoke with a new group of people starting a pain management programme yesterday. I told them, as I tell all the new groups, that their pain would probably increase during their time on the programme – and that if we hadn’t managed a flare-up at least once, we had failed our job! The participants looked uneasy at this, and laughed nervously. One brave chap said to me ‘but our pain is always high, you can’t make it worse!’

I stopped and thought for a while – and you can see I’m still thinking about it – but at the time I asked the group if they had noticed fluctuations in their pain. Does their pain ever stay at one level all the time? Do they ever notice times when it gets worse? Do they notice times when it goes back to ‘normal’?

The truth is, pain like almost everything, does fluctuate. As humans I’m not sure that we can sustain a steady state in any emotionally-charged experience. Think of anger…it ebbs away after time; peace…it becomes energised shortly; joy turns into contentment; irritation turns into grumpy…
You know what I mean? We don’t seem to be able to maintain a peak or trough for very long, especially if we acknowledge that we’re feeling a feeling and then carry on with life.

Something about acknowledging (rather than trying to ignore) and accepting (rather than trying to control) means that this process of returning to a baseline level of euthymia happens more readily. Fear of experiencing that feeling seems to make it much more difficult to allow it to dissipate.

In case of pain, because it is so influenced by emotion and thought, readily fluctuates – but patients and clinicians alike are fearful of increases, perhaps forgetting that if it goes up, it goes down also.  Perhaps part of therapy is for us to instil confidence in our patients that they can live rich lives despite fluctuations in pain – this means they need to have increases in pain while they are having therapy with us, so we can demonstrate our confidence in their ability to cope.

Do I embrace pain? Not likely! I don’t enjoy having chronic pain, but I can remind myself that by acknowledging that I have it, not judging it, but allowing it to pass on, it can and will reduce again. And even if it doesn’t reduce, I can still live my life, doing things that I feel are important, feeling confident that all things pass. Can we believe that on behalf of our patients? They can and do survive (more than survive) with pain that goes up, that goes down. This is the nature of pain.

Today, pause for a moment and do a Body Scan (mentally go through your body from head to toe and identify the sensations you are experiencing). Just note the sensations – don’t name them, don’t judge them, just be aware of them. Spend the space of 10 slow out-breaths to do this. If you’re completely painfree, I’ll be surprised. Just experience what you do experience, and allow space for it to happen – whatever it is. Then move on to live your life, in the moment.

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