I was trained as a clinical psychologist and went on to work with many patients who had long histories of chronic pain conditions. The best skill instilled in me during my training was the ability to listen and to hear my patients. I wanted every patient to be heard. I wanted them to feel cared for. AND I know that I couldn’t “fix” every patient.

Over time, I came to appreciate the power of their words: the significance of my patients’ stories, the power of their providers’ pain explanations, and my words - how I understood their described experience and how I was going to help them.

Each day was different. As I became more experienced, I didn’t have a script for how I talked to my patients about their pain. There wasn’t one. There was no specific combination of words that I could apply to every person in pain. There was too much uniqueness, uncertainty, and years of experiences for them. Instead, I searched for their unique story, in every chart I read through, in my conversations with them, and in what they told me. Their unique pain story could be found if you listened hard enough. I was also always seeking a better way to talk about their pain with them, using their words, their framework, their experience, their story.

I wrote very detailed (and I’m sure some past colleagues would complain that they were too long) notes for my initial consults with patients. They were long because they were full of really important notations of the patient’s own description of their experiences with the medical system and their pain. Nothing went wasted. When we are trying to hear and understand the nuance of someone’s pain story, all of the words and language is important.

Why? Because words carry so much meaning. And beyond meaning, it all ties back to the link between the mind and the body. When someone shares their story out loud, they become neurological events, part of a circuitry where the brain transforms them into knowledge, thoughts, opinions, and even danger signals.

In my first meeting, the most important interaction I’d ever have with them, my goal was to listen. Let them talk. Help them feel at ease. Display empathy. Show unconditional positive regard. Match the education with their readiness - use the right language at the right now. Instill hope.

Going back to words. In a conventional medical setting (or any setting, I suppose), the intentional and careful delivery of words holds a lot of power. Words can activate our dopamine reward system (or our “feel good” center). Words can also activate our endogenous opioid brain networks (or our “pain relieving center”). And, if we aren’t careful, when we deliver unhelpful language, it has quite the oppposite effect, adding distress, fear, and threat to their story and fueling a cycle of chronic pain.

Despite all of these efforts to listen, empathize, validate, and carefully deliver my words, some people were not ready for this or for the change that I was guiding them toward. Some left. Some stuck around for a bit and then left. And many of them returned later. It was all okay.

A critical task as a pain psychologist was to help other providers shift their beliefs to the bigger patient picture and their words to more neutral, more rational explanations of pain. Another critical task was to help the patients rephrase their inner monologue, influenced so heavily by the triggering pain explanations they’d heard from their providers over the years:

• You will end up in a wheelchair

• You will have to learn to live with the pain

• This is the worst I’ve ever seen

• You’ve blown your knee

• This is bone on bone

• Your disc is bulging/herniated/ruptured

• Degenerative disc disease will eat away at your spine

Over and over I reminded them:

1. Your pain is real.

2. Pain is more than just mechanical.

3. Pain is an alarm system.

4. We are bioplastic.

5. This brings me to the fifth and final building block of my educational approach and pain philosophy. Words are powerful. Even just 10 minutes of neutral, rational, carefully chosen education can change everything for a patient with years of chronic pain, and most aren’t getting it from their providers.

Understanding pain can have a profound impact on a patient's engagement in mind-body treatments, coping ability, recovery, and life.

Education provides you the power to take the next step in managing your pain. You want to do the things you enjoy (or even basic daily activities) without flaring up your pain. For a limited time, you can grab my free video tutorial to get you started:

3 Simple Steps to a Balanced Day... Without the Flare-Ups.

This free video tutorial is dedicated to helping women with pain begin to find confidence to return to the moments, activities, and people they love the most.

I’m here to give you little, digestible bits of information to help you better understand your chronic pain. I’m here to make this accessible for you and for many. Let’s start giving you the information you need to redesign a life that is bigger than your pain. Thank you for following along as we built the main components of my pain philosophy.

Source: Louw et. Al (2018) Pain Neuroscience Education

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