Chronic Pain Calls for Compassionate Listening

October 28, 2014 by Emmi Solutions with permission.

Guest Contributor: Gonzalo Bacigalupe, EdD, MPH – University of Massachusetts Boston, American Family Therapy Academy

Chronic pain, a persistent and recurrent pain not related to cancer pathology is common, about a quarter of us suffer it. Despite its dramatic impact on quality of life, it has a bad reputation. Patients are dissatisfied but health care providers are too. Opioids are often prescribed but just mentioning the word has negative undertones. The fear that patients will misuse them or are some sort of an addict leads to a further burden. Not only the patient has to suffer the physical pain and its emotional and psychological consequences but patients have to also endure a continuous suspicion about medical treatment.

In research interviews of people living with chronic pain, they are clear about what they think: Doctors “don’t want anything to do with you.” Their deep distrust and dissatisfaction with their physicians is contrary to any call for shared decision-making and open communication between clinicians and patients. Patients perceive clinicians as blaming them, of lying about their experience of pain, and of drug addictive seeking, regardless of the presenting pain even if congenital. It is as if having chronic pain makes patient undeserving of treatment. They “give you the cold shoulder,” a patient told me in a focus group.

Quality of care in the case of chronic pain is, as a result, low. Feeling unheard and consistently not respected by clinicians, patients deepen their sense of isolation, stigma, and may end hiding an addiction that requires a genuine clinical intervention.

What makes a difference? Patients look for affirmation and for clues their clinician is listening and paying attention to their story. Since chronic pain requires a subjective assessment, paying careful attention to the nuances of the patient’s context—family and work particularly—is not optional. Numbers on a scale do not mean much for a patient whose pain is constant, recurrent, and not getting better.

Chronic patients prefer a clinician who is also open to alternative medicine strategies and who is not scared of prescribing them as well as learning from the patient about what of those really makes a difference. Yoga, acupuncture, massages, and other strategies can be very effective for patients. Patients appreciate making them available within the context of clinical care. Integrating mental health and strength-based psychotherapy approaches can also be helpful, countering the usual stigmatization of chronic pain as a hypochondriac behavior or even loaded mental health diagnosis.

For clinicians, working through chronic pain may require not only a traditional medical toolbox but also some soul searching and questioning of the healthcare provider ultimate aim: to cure. Chronic pain is often not treatable; it can only be managed. Learning how to cope with a patient that may require continuous support can test the person of the doctor as solving the problem. A compassionate listener requires integrating, therefore, the role that it is often reserved to psychotherapists.

Chronic pain interventions, therefore, not only requires listening to the patient story but to our own anxiety and distress about not being able to eliminate the symptoms completely but to palliate some of the suffering.

Being helpful to these patients may, indeed, be a task that demands more health literacy on the part of clinicians.

Gonzalo Bacigalupe is Professor of the Master of Science in Family Therapy Program and the PhD in Counselling Psychology, College of Education & Human Development at the University of Massachusetts Boston. He is President of the American Family Therapy Academy and co-principal investigator of a Patient-Centered Outcomes Research Institute Pilot research project: Influence and evidence: Understanding consumer choices in preventive care.