It has long been one of my Sunday morning routines to read the Sunday New York times. In the July 12 edition of the “The Times” Joanna Burke offers an interesting commentary that caught my attention, “How To Talk About Pain”.
There are several, as David Butler would say, “ nuggets” contained in here that provide insight into value and difficulties in effective communication between those in pain and those who want to help them. In reading through the piece I was struck with how many different ways “pain” was used and how many different definitions “pain” had. It is used in the contexts of describing nociception, existential threat/angst, physical suffering, emotional distress, loves lost, etc.
“Nociception” does not carry the lyrical, emotional, and poetic simplicity of “pain”. That lack of an emotional evocative meaning, however, is appropriate. Nociception is the dull, although sometimes stimulating, message from tissue to the brain. Pain is that complex response of the brain that often can only be best expressed in the emotion of song or poetry. No one is going to write a song to nociception. Inserting “nociception” appropriately within the piece and maintaining “pain” where it speaks to that complex output of the brain would make the clinical communication about the author’s status much easier and clearer. However, it would not make for stimulating reading.
Two passages that I liked speak to the need for those in pain and their caregivers to understand the complexities of this confusing brain output and the need to communicate with technical accuracy, poetry, and empathy.
“We may no longer believe that pain is sent by God to test us; and we may no longer need lengthy descriptions of pain to arrive at diagnoses. But pain will always be with us, and by listening closely to the stories patients tell us about their pain, we can gain hints about the nature of their suffering and the best way we can provide succor. This is why the clinical sciences need disciplines like history and the medical humanities.”
“When I was in the hospital, I told a visiting friend that my pain was “beyond language,” only to have him remind me that I had been speaking about my suffering for the past hour. Perhaps, he mildly remarked, the problem is not that people in pain cannot communicate, but that witnesses to their pain refuse to hear. I was so struck by his observation that I forgot how much pain I was experiencing. For a few moments, his empathy overcame my suffering.”
If pain were only nociception, science and technical skill application should provide the answers to its management. If recent science, clinical studies, and the conversations that this blog has generated demonstrate anything, it is that pain is a much more sophisticated condition than we had ever anticipated when we entered our professional training. As Burke indicates, the ability to produce that empathic moment is often critical. A component of that ability requires an active form of communication that involves listening and emoting both verbally and non-verbally. The skills of effective communication can be practiced and developed. The empathic (artistic?) component, however, often requires us to go outside our cloistered scientific and clinical worlds. The spoken, performed, and visual arts and literature reach our mirror neurons and deep parts of our brains where our joys and our existential threats are processed. I am convinced, as a pain practioner, that we will not be able to reach those deep parts of our patients’ pain experiences until those same areas of our brains have been tickled. There is a science and an art to what we do. I know this is simplistic statement, but – Do we need” the science” to deal with inputs to the brain and “the art” to deal with those parts of the brain where those mirror neurons and joys/fears work to guide the output?
John Barbis is a physical therapist at Main Line Health. He has BS in biology from Haverford College and Masters in PT from Stanford. He has been practicing since 1978, a McKenzie certified therapist since 1991. He has taught at Temple and Jefferson and has held posh posts on the APTA, McKenzie Institute and Greater Philadelphia Pain Society. Enough said? John knows as much about patients and about treating them in the real world as anyone. Add to that an enthusiastic and it seems daily assault on the literature, he is a formidable clinical thinker. If you disagree with this, or with him, we advise you to not choose physical violence to settle it because John is a dead set bonafide dynamo on the squared circle. Clearly he did not write this bio.