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Values and why they matter in pain management


I’m away from my desk, visiting Auckland this week, so this post will not be in my usual format. Having time away allows me breathing space to think about things (even more than usual), and I’ve been thinking about values and their place in our lives.

We all have values, things we believe are important. Values underpin the decisions we make, our priorities, and even the way we interpret events that are usually considered value-free. Value judgements are part of being human, I think. They can be prosocial – or not.

When I looked up values, this definition appeared: the regard that something is held to deserve; the importance, worth, or usefulness of something. Some values are explicit, things we’ve deliberately decided to place importance on, while others are implicit, things we’ve not fully thought about but have emerged as part of our culture or family or upbringing.

In pain management values are imbued in all we do. Some people explicitly value reducing pain intensity as their ultimate goal. Others value reducing distress associated with experiencing pain. Still others consider that enabling people to reduce the disability associated with pain to be the most important part of pain management.

I wrote recently that pain and suffering are two distinct constructs. That pain is an experience associated with the threat of tissue damage but doesn’t necessarily equal suffering. That suffering is about loss of “self-ness” or losing aspects of who and what we expect from ourselves or believe about ourselves. I believe we can always find ways to help people retain or regain a sense of self, even when it may not be possible to alter the experience of pain itself. And that reflects the value I place on being able to express who I am. And my values inform how I work with people.

Inherent in much of our health practice is the idea that people should be able to remain independent and do what they value. Ideas of independence are value-laden – reflecting beliefs that individuals should be able to make their own decisions. But this doesn’t hold in some cultures where groups or families or a collective are seen as more important than any single individual. I’ve seen conflict occur in a health service where the individual I was working with came from a culture where family orientation, support to remain within the family and receive care was prioritised. The service I worked within prioritised independence and helping the person become more capable and independent, while the person and her family prioritised family relationships and maintaining this person’s dependence on family care. No matter how hard we worked with this person, we couldn’t achieve joint goals because we were working at cross purposes.

Because many values develop within a cultural context, and are implicit and not really ever examined, within healthcare we can be completely unaware of how our values might influence how we work with the person we’re seeing. And vice versa. Some of the challenges we face as healthcare providers can derive from our own unexamined implicit values assumptions.

For example, we might see someone as being unmotivated, as not putting effort in – they may see us as unsympathetic, as not listening to their concerns. They may believe we’re meant to “do the work” for them, we may see this as “being dependent”. They may believe that healthcare should be able to fix everything. We may recognise we can’t. Or we may believe we should be able to fix everything if we try hard enough.

Should values be left unexamined? Should we even think about questioning our own assumptions and those of the people we see as clients?

I don’t advocate trying to change someone’s values, but I do advocate sitting beside them and examining them. I think we need to recognise that values exert an influence over what we do, how we do it and what we prioritise. Mostly I think we need to look at our own implicit assumptions, and judge them against a criterion of workability within a context.

What this means for me is taking the time to question myself whenever I hear myself using the word “should”. I use some of the old cognitive therapy strategies of downward arrow (https://sites.google.com/site/psychospiritualtools/Home/psychological-practices/identifying-core-beliefs) to check in with why I think something is important. And then I ask myself whether it’s workable – and whether it takes me closer to, or further away, from the life I want to live.

Here’s a thought: what about trying this yourself. Ask yourself why it’s important to do whatever it is you do, then ask yourself how well is it working. You might be surprised at what comes up for you. I’d love to hear your thoughts!

4 comments

  1. If I ask myself why I exercise i would say because it makes me feel better and It is good for health in general . If I ask myself if it is working I would say yes as i consider myself in good health despite my spinal surgery and chronic pain. I have good vitals and low cholesterol, good weight , good cardio etc, so in this case yes. I feel better when i exercise regularly.even though it is sometimes a struggle. This one seems simple.
    If I ask myself why I cannot say no to people I would say I am not sure of the real reasons and does it work well for me no i don’t like it but it would take a lot of self reflection as to why i do that. I think though it has much to do with my attitudes and beliefs and it would involve changing them and some CBT i am sure.

    1. As there has always been. The problem is: what are you treating? How will you know it has worked? Can you distinguish between natural regression to the mean, placebo, normal healing time, and distress reduction and is there a difference between the outcome you obtain and that obtained through time…
      Pain management is and always has been fraught with challenges that make learning to cope with pain extremely difficult.

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