Take Pain Seriously

The English language has always been tricky for me. Not because I am a skilled, multilingual savant. More that I am a bogan from Newcastle that grew up in the 80s who learned more slang and mostly converses in various nasal intonations of “yeah, nah” rather than the Queen’s English. One is a song by Metallica, not a way of describing myself.

Having only butchered foreign languages when I have travelled I am immensely jealous of those who can not only converse multiple ways, but also across multiple linguistic structures.

I have heard from people who have learned English as a second language that it is tricky to learn, it doesn’t make as much sense as a Latin language like Spanish. One of the reasons is we have so many ways of saying the same thing, especially when it comes to explaining what you are doing or going to do. I think this has something to do with future tense, but you will have to ask someone

Eg I am running, I am going to run, I run, I will run etc.

(Well not me, as running sounds boring AF, but you get it. Imagine I'm a character in one of those books that teach kids to read - “This is Dave. Dave will run. Bullfuckingshit Dave will run, is there a tiger after him? Didn’t think so.”)

But, until we get taken over by robots and are forced to converse in 1s and 0s, it is still the best way to convey something to another person. Body language and tone of voice convey most of the feeling or intent, but in terms of actual information transfer, it’s language that still does most of the work for most of us.

So in my world of helping people understand what is going on in their painful bodies, we rely on it immensely.

Even without factoring in my boganness, any ESL difficulties and any medical or other reasons for speech impairment, we are already in murky waters.

The person asking me for help will, upon listening to questions from me, have to convert a series of feelings, events and perceptions into words to give me an indication of what they are experiencing in the past and currently.

My brain hears these sound patterns and automatically converts them to patterns and ideas about this person (well it actually thinks about how it would feel if it were me - it’s my job to resist this temptation - but we will go into this in another episode) and what it must be like.

So we are already a few layers down in word based interpretations and models of real world events. So you can see where there can be misinterpretation, some confusion and the need to be clear and clarify what the person with the problem means.

Then through in second languages, speech difficulties, or learning most of you vocab from Thundercats and Voltron and we can soon see it is worth practising regularly to ensure the best possible outcome.

There is another complicating factor people in pain often have to overcome. This is especially the case with any minority population, including women, children, older people, people with mental health problems, different racial groups, people with disabilities and probably any other you can think of.

It is when the health professional who is asked to help, renders a personal judgement on a person’s pain story and, in various ways, comes up with the idea that either 

1. It’s not that bad, or
2. It’s not real

Chronic pain is a leading cause of morbidity, years lived with disability, health cost and global burden of disease.

As we have treated it, it’s also gotten worse.

There is no doubt that a large part of the chronic pain burden is due to the way in which the health and medical system have treated people with chronic pain.

The iatrogenic (fancy word for caused by the healer) effects of chronic pain management continue to cause undue suffering.

3 words make this more likely to be successful

TAKE PAIN SERIOUSLY

So from a societal stand point, persisting musculoskeletal pain exerts a massive financial toll. Notwithstanding the cumulative impact of chronic pain on individuals, their families, the communities in which they live, even future generations. Even from a purely financial point of view, paying attention to changing it makes massive sense.

This is particularly the case when so many cases of chronic pain could be avoided with better health care before it gets there.

Which brings me to the second meaning of Take Pain Seriously.

I have treated 1000s of people with chronic pain problems over 20 years. Some of them have shit luck, with systemic diseases, hereditary factors or surgical procedures making them more likely to have stuff that hurts and keeps hurting.

The vast majority however, have shit stories about asking health professionals for help and getting ignored, patronised, petrified by stories of how fragile they are or fed bullshit about how the body works.

In our vigorous belief in ourselves as Jesus-esque, infallible saviours of humanity, health professionals have ignored the fact that there is a shit tonne of stuff we don’t know about pain, plenty of things that occur that we just don’t understand and the fact that, more often than not, it’s just pretty fucking weird.

So rather than being honest and listening to how it affects the only possible person on the planet who knows anything about it - the person feeling it - and help them work out a plan for it to not be such a factor in their lives, we construct stories and causes showcasing our intricate and highly trained expertise in having our heads firmly wedged up our own arses. We take ourselves seriously instead of taking pain seriously, and people suffer.

A quick survey of health professionals of any brand will show results indicating a high majority of success with patients and their painful problems.

“I get great results, my patients love me” etc. 

Myself included.

So then, looking at chronic pain incidence, costs and outcomes, where are all these suffering people going? Is there the one health professional, in some backyard basement clinic, destroying peoples lives en masse and skewing our averages? Or could it be perhaps, that we remember the people who get better and direct the others into the vast space beyond our memory and consciousness.

If a person is not getting the outcome they want do you think they stick around to tell you about it?

No.

They stop coming.

Hopefully they head somewhere else and get a better result.

Many stories I hear, unfortunately, continue on the same path, a different brand of bullshit that doesn’t work and ongoing suffering.

Or, they just stop trying after having all the hope leached out of them by repeated attempts to ask for help and feeling abandoned.

In physio land, the taking of pain as less than serious is a big problem.

A muscle tear, a broken bone, these tangible things that we can recognise get taken seriously. But a lot of, say, back pain, which arguably is equally or more disabling, is often not.

“Don’t worry about, most of the time it goes away on it’s own”

Which is true, but not a normal experience for a person.

We confuse expected outcome with individual experience and project our lack of concern onto a person who, by virtue of the fact they have sought help, is concerned.

Many painful tissue injuries have obvious aspects that require explanation, rehab and support. The person is very concerned and we, for the most part, explain the situation and what is required very well, to the point that most of these have good outcomes.

Many painful things have no tissue injury, and still require explanation, rehab and support. We understand this less, but the person is no less concerned. In many cases, pain without an obvious injury is more concerning, as this experience is often unusual for the person and less talked about in society.

If we look at back pain specifically, it is true that most of these episodes will be gone by 6 weeks. 

(aahhh - who wants 6 weeks of back pain??)

The ones that linger, however, LINGER. For many of these people the main reason is that their body has had no reason to stop things being painful. The care they have sought has increased their bodies' need for pain to continue - the reverse of what should happen.

It is these people that health care has failed and needs to improve for.

It is these people that show us why we need to take pain seriously.

Before this happened to them, most of these people were like you.

Not crazy, not lazy, not soft, not weak, not nervous.

Just living.

There will always be painful things, people with pain that sticks around and things we don’t understand fully or completely control.

But there remains a huge amount of people who are worse because of their interaction with health care.

We do not need to solve all of pain’s mysteries to take it seriously and help people. It is entirely possible for someone to recover without having an in depth understanding of neuroscience, biology and pain theory. But it’s very rare for someone to spontaneously recover in the presence of pain, fear, uncertainty and decreasing ability to do the things they love. This is our job, to listen to what has happened and help people navigate back to life as they know it.

As a health professional, I know I will not be able to help everyone. But as a fucking bare minimum, I absolutely must never make anyone worse.