Susan E. Mazer, Ph.D. Blog

Thoughts and ideas on healthcare

Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.

When Pain is Pain

September 21, 2018

Ready for “OUCH!”

Pain teaches us what it is very early on in life. We learn that if we hurt, we get a kiss, or something extraordinary from someone bigger than we are, telling us “now, it doesn’t hurt any more, right?” However, sometimes we learn differently and suddenly and unforgettably.

When I was a child, I had scarlet fever twice, something I should not have been able to do. The first time Dr. Budson, our family doctor, came to the house, he examined me with his cold hands, and then asked me to turn over saying that he was only going to “pinch” me. Well,  at 6 years old, his “pinch” was my “OUCH!”

Therein lies the challenge of preparing a patient for pain: we don’t know what it will really feel like to the patient.

As it was for me so many years ago, a patient’s experience of pain is neither generic, nor fully understood, nor necessarily predictable. And, the same way that we cannot fully describe or translate our emotional and physical experience of love, we cannot communicate to another person what our own pain experience is or what someone else might experience.

I have spent this year researching and writing about pain. Perhaps the only conclusion I’ve come to is that the confusion among us about pain persists. Is pain physical? Is it emotional? Is it an injury or the outcome of an injury? Is there anything about pain that is universal? Does its expression relieve it? Did my “OUCH!” help me at all?

One answer to these questions: Sometimes.

Everything can be true. Pain can feel physical when it is not. It fools us. Even the physical feeling of pain may be confusing. Shingles will feel like burning or scraping, but it is actually caused by a virus in the nerve endings.

Pain is universal only in the fact that we all know what it is and when we have it. But, that is possibly the only thing about it that is universal.

 Pain Beliefs Matter

A 2012 study showed that beliefs about pain held by nurses who cared for non-verbal patients influenced their choice of methods of pain control, how much medication they administered, and how they interpreted the non-verbal communication. This study and others indicate that the pain belief of the clinician informs how they respond to the expressed needs of their patient.

The Role of the Caregivers: Placebo and Nocebo

Patients can be predisposed to more or less suffering by their own expectations which are fed by the attitudes and opinions of those closest to them such as family and caregivers. A 2016 study further confirmed that the nocebo effect, negative symptoms, was easily triggered by negative suggestions. Patient expectations influence the patient experience.

The study warned that care should be taken to not inadvertently cause more suffering by well-intended concerns about “what might happen.”  Necessary warnings on medication labels that include a long list of possible side effects may have a nocebo effect.  Florence Nightingale warned about this in Notes on Nursing, writing that what happened to another patient at another time with a similar or different condition is irrelevant to the experience of their own patient and sometimes harmful because they create negative expectations.

Alternative to Pharma

We did not always have pain medication.  In fact, not until the end of the 19th century, did we have aspirin.  However, once discovered, non-pharmaceutical interventions took a back seat to the “magic bullet.”

Alternatives such as Guided imagery, acupuncture, positive distractions, exposure to nature and music either through the C.A.R.E. Channel or a window looking out on a park,  virtual reality, going for walks, or an engaging conversation – all of these have been shown to be effective.

However, none will work all of the time for everyone. Thus, the tool box model.

Dosage is Not the Only Measure

Finding “the right dosage” is not the only key to easing pain.  Supportive relationships, communication, meaning, compassion, and empathy can improve patient ability to cope with their own pain relieve suffering caused by fear and anxiety.

How a patient manages pain has so much to do with what it means to them to those who care for them.

It’s worth thinking about pain as a whole person event.  Working with our patients to find multiple methods from which they can learn what is effective empowers them to take their power over their own circumstances.

(check out my white paper on Pain Management and C.A.R.E. for the research behind why it is effective…)