Pain Care: 10 Things We Can Do Better and 1 Thing We Can’t
(What I Learned from People at the San Diego Pain Summit)
First a story . . .
Cody lives with pain every day. He frequently visits his local clinic for treatments and advice on managing his pain and daily life. Sarah goes with him.
After a recent visit for help managing a pain flare Sarah told her friends and family: “Everyone was so nice. They were really caring and gentle, they listened to us, and made everything so easy to understand. Cody felt it too. We came up with a good plan together. I’m so glad we found them, they are so easy to talk to and I feel like they really care about me . . . and my dog.”
A few days after the visit to Cody’s vet, Sarah visited a health professional for her own issues, and told her friends afterwards that: “It was really stressful. The waiting room was cold, and the receptionist acted like I was bothering her. Everyone seemed super busy and distracted and I barely had any time to talk or ask questions. They showed me some things to do at home, but I don’t really know if I’m doing things right. I felt like I was treated like a number, not a person. I don’t really want to go back, but where else would I go?”
This story is fiction, but all too familiar. I was inspired to write it after a fellow participant at the San Diego Pain Summit last weekend said:
“Veterinarians get more pain education and are better at compassionate care than most health professionals.”
Yikes. It struck me that I had experienced the same thing for all the years I have owned pets and interacted with vets. My percentage of negative experiences with vets is extremely low. My percentage of negative experiences with health professionals is extremely high. Especially the experiences I had when I was in unrelenting, confusing, and debilitating persistent pain.
What’s up with that? What are vets doing more of that we, as health professionals who work with people in pain, can do better?
Last weekend an amazing group of health professionals and people with lived experiences of pain gathered to listen and learn about pain care from other amazing health professionals and people with lived experiences of pain. Many of us then collected around a virtual fire pit to try to sort out and synthesize what we learned. We wrestled with meanings, how we could apply new or familiar ideas and knowledge in our practices, and what we could be doing better.
I heard repeated words and themes from these wise people:
10 things we can do better (and one we can’t):
- Being a human. People living with pain want and need to have conversations with us — human to human. We know how to have conversations. We are not the jobs we do; we are people meeting with other people for the purpose of co-creating together. This is a vulnerable, less predictable, but necessary way to practice better.
- Being a goat. This is one of those firepit stories SDPS is famous for. A logo is being created and t-shirts are being planned. It may go SDPS viral. Time will tell. Stay tuned.
3. Practicing compassion and giving validation. More compassion and caring for, less assessing and labeling. Believe in the lived experiences of people in pain. Validate those experiences as normal human responses, rather than abnormal pathological ones. Avoid trying to over diagnose and fix, and remember the people we work with are humans, not hips.
4. Asking good questions and listening for answers. Our words matter. Allow space and time for reflective answers. It’s important to hear the stories and listen for the answers coming from the person in front of us instead of those we expect or want to hear inside us. We can be better at not judging — body language, stories, cultural differences, or any other differences. Be a listening co-collaborator in finding answers that work for each person.
5. Helping people live life well, not just manage pain well. We want to help people live meaningful lives, not just help make their pain better. None of us really knows what self-management means anyway. We can’t define it because it’s about living life well, not managing pain well. “Self-living” may have popped into my head and out of my mouth during my Q & A session, but it really was a summarization of what I was hearing from most presenters and attendees. Life is messy and unpredictable. We can be better at exploring DIMS and SIMS, the “doing data” of peoples lived experiences, and supporting them in discovering and developing skills for living their best lives.
6. Being trauma informed. Most people have experienced some trauma and people in pain may have experienced more trauma. Parent trauma affects a kid’s pain experience. Trauma affects genes and can influence future generations. High ACES scores have correlation to the development of persistent pain. There’s so much to learn about the effects of trauma on the pain experience and so much to learn about how we can become better at trauma-informed care. (Watch Melanie Noel’s amazing research for updates)
7. Gathering story data and become co-creators in writing better stories. Talking less, listening more. Exploring stories and lived experience. Will we prescribe or co-create? Be human co-creators or healthcare dictators? The field of Narrative Medicine has much to teach us to help us develop the skills to best support people living with pain to write new, better stories in their lives. (Follow John Launer, Narrative Rx, and engage in Narrative Medicine workshops to learn more)
8. Challenging our methods and understandings to provide better care. Wear a lampshade on your head if you must — to help people understand pain science. Stop searching for Sasquatch, and read super complex philosophical papers that make your neurons spark wildly all over the place until your head almost explodes. Learn from people living with pain who tell us what they need from us. Stay curious, keep a growth mindset, seek out people who challenge your biases, try new strategies, and keep showing up at SDPS every year to work on being better!
9. Advocating and educating to effect change in our professions. Be different. Be an agent of change where you live and work and to the greater world you live in. Changes will only come if we step up and speak up about the changes in pain care that need to happen in our professions, and our societies. It’s not comfortable. Do it anyway.
10. Being curious. Staying curious. All the time. About everything.
The one thing I heard this past weekend that we can’t be better at:
1. Being perfect. How often do we measure and compare, judge, and try to control the outcomes to prevent potential failure?
Striving for perfection, setting unrealistic expectations of ourselves, and tallying our mistakes leads to burn out. Life is messy, people are complex, pain is weird, and uncertainty is uncomfortable. We can’t be perfect. We will experience Mis-takes.
But, being kind and self-compassionate, finding a meditation practice that fits us, (permission to run, box, color, or whatever works for you), integrating more restorative and pleasurable activities in our daily lives, having someone to be accountable to and to reflect and process with, learning improv and laughing more, can all help prevent burn out. (And taking Sandy Hilton’s burnout prevention workshop at next year’s Summit)
I unfortunately had to miss a few sessions, so I’m sure there were more learnings people could add to my list. Animal themed inspired lessons seemed to be happening all over the place. Howling like wolves? I want to see video, or it never happened.
Shout out to everyone I met and chatted with this past weekend. Thank you for showing up and sharing. I’ve learned so much from you that will help me to become better at caring for people living with pain. More than I have even remembered yet.
Until we meet and chat again around a virtual or real firepit, thanks for being the best goats ever!
See you next year! 😊
