Resource Elements

  1. A clinician focuses on understanding the story of his patient’s experience with pain.
  2. A patient needs to be vulnerable enough to tell their story.
  3. Not all pain can go away, but it can change.
  1. Pain is complex, sometimes associated with tissue damage and sometimes not.
  2. Three dramatically different pain stories.
  3. The old approach associated with pain with tissue damage, the new approach looks for other factors.
  4. Hearing the patient’s story of what pain means to them is the bridge to going forward for the patient

Russell Wimmer is a Certified Physician Assistant and a member of the Oregon Pain Management Commission with two main parts to his comments: a) pain is a more complex concept than pain is physical suffering, or it results from a bodily disorder, and b) hearing his patient’s story is the most important and productive interaction he has with them.

He describes the well-documented case where a construction worker observes a spike sticking up through his boot and experiences tremendous pain.  Eventually with enough narcotics to calm him, they cut the boot off and find the spike between his toes, so no physical injury.  His pain was real but tissue damage wasn’t present, but his pain was real.

A 90 year old patient of his said her hip was bothering her for 2 weeks, walked up o his second floor office and said: ‘they made me come here’.  An x-ray revealed her femur broken but she wasn’t in a lot of pain.

The old approach assumed that if you had tissue damage, then you have pain, so when the damage is fixed the pain will go away.   But the truth is you can have pain without damage and damage without pain, a more complex situation.

He tells a third story of a patient who developed chronic pain after several abdominal surgeries.  Over the years a series of various clinicians had eventually prescribed methadone, which controlled the pain better than other medications.  Her next clinician refused to renew the prescription because they assumed she was addicted, and she eventually came to him.   He was able to change her pain experience because he listened to her story and was able to help her have more influence over her pain.  She still has some persistent pain but her life is very different.

He asks: ‘why is pain so difficult to communicate?’.  They just stop trying’.   His approach is: ‘I just want to know your story.’   It takes vulnerability for the patient saying: ‘I just want you to understand’.   How pain affects the patient is what he wants to hear.   He takes his eyes off the screen and asks: ‘What do you mean?’  That is the bridge that opens the opportunity or others to help change the story.   No one was really hearing what she was saying.

He learned this perspective by shadowing Sharna Prasad (PT at Lebanon hospital).  Not all pain can go away, but it can change and the process starts by the patient sharing what pain is to them so a whole team can help make the change.   Going forward is the only thing to do.

Please click on the link to open this 12-page PDF transcript in a new widow: 1016-Pain-Controlling-the-Narrative

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