A brief article in yesterday’s Guardian highlighted one of the inequalities in pain relief. The author, Grace Rahman, focused on the question why black patients are given less pain relief in the light of recent research. With pain being the most common cause of Emergency Room visits, there is plenty of data to analyse. This is likely to be the same in the UK, pain being the primary vehicle that takes people to seek help. As a significant aside, it astounds me that pain is so low on the public health agenda in terms of funding for research as well as overall recognition.
Depression and chronic pain take the first two positions in global health burdens — they cost us the most. Yet where are the campaigns? Where is the TV coverage? They do not exists despite the fact that pain is a universal experience, except in an unlucky few with a rare genetic disorder, which is normal and necessary for survival but so deeply troubling when it persists. Therein lies a major issue contributing to the question penned by the journalist: why are black patients given less pain relief?
Previously, young babies may not have been given pain relief and older people may still not receive adequate pain relief, especially those who are cognitively impaired. The aggression seen in someone suffering dementia may well be due to pain that a simple analgesic would relieve. The misunderstanding of pain underpins all of these contexts, resulting in poor treatment that is based on the wrong thinking. The lack of pain education is incredible when you consider it in this light.
A study quoted by the author highlighted the knowledge gaps of white medical students who rated pain levels to be lower in black people when looking at case studies. Why would this be the case? It was thought to be due to ‘entrenched ideas’ about how people differ biologically and about how they behave in relation to using medication.
Each person is unique with their own personal experiences and narratives of their life to date. This makes an individual’s pain unique, and at any given moment our lived experience that could include pain, is also unique. I have never had this moment before and never will again. So even in the individual, the pain is never the same. We are always changing as we build up prior experiences with every passing moment in time. Understanding this is important and also delivers hope, because when combined with a working knowledge of pain and what we can do to actively steer a desired course within realistic parameters, we actualise change.
Therefore, as clinicians and as a society we must appreciate that each person’s experience of pain is unique and just as they person says it is — listening deeply is vital to gain an understanding with the required compassion. Just spending those moments with the person, allowing them the time and space to describe their experience allows a calming. We must certainly appreciate culture, gender and beliefs as we impart the truth behind someone’s pain, giving them knowledge and skills to overcome their pain and what fuels the sensations. This is the same for every person — whatever the colour of your skin, age or sex. Deep listening, compassionate speech and a focus on what action to take in this moment.
Much suffering comes from how we think about our pain, which is why we feel better when we understand pain and the fear dissolves. When the fear and worry decrease, so the pain eases and we can focus on what we need to do to get better. Fear, worry and depression are based on the contents of our thinking from the past or the future, neither of which exist except in our embodied minds. The only real moment is this one, now. Practicing being present and seeing what is actually in front of you by using the breath for example, allows the person to let go and concentrate on this moment. This is the foundation for moving onward in a chosen direction.
Medication is part of overcoming pain. It can be useful when used wisely within a plan that includes how and when the drugs will be reduced. Of course this is individualised to the person, their condition and their needs. Many people choose not to use pain relief, and certainly the opiate based drugs. Everyone wants relief and this should be a primary aim of any treatment programme, however, the person needs to understand how they themselves via their own thinking, perceptions and actions can change their pain. This is the main bulk of the work for that person as they need to be able to coach themselves at any given moment, each day. The strategies and exercises become healthy habits formed through practice that interweaves into the day. Continuing with normal activities in tolerable chunks maintains a sense of living a life and I often say to people that they can only get only get back to living by getting back to living — doing the things you want to and starting doing the things you have not been doing, bit by bit; thinking ‘can’ instead of ‘cannot’. It is just that you need some ways and means to do so as you build up tolerance by following a programme. A simple analogy is all the background work that an athlete would do in order to perform their sport. The programme is the background work.
Bearing this in mind, there is only one way and this is to consider and treat the unique person as much as the condition. In doing so we learn about their suffering and guide them forwards with treatment that gives the person working knowledge of their pain and skills so that they can coach or mentor themselves forward by thinking and acting in such a way as to take them forwards.
Pain Coach Programme for persistent and chronic pain | t. 07518 445493