Pain. There’s a lot that is misunderstood about this four-letter word we are all familiar with. For many of us, physical pain occurs after an injury and emotional pain occurs after suffering a loss, but with time, that trauma can heal or become easier to manage and we are able to move forward. But for many, the sensation of pain sticks around, afflicting them every single day. For them, pain has gripped onto and changed every component of their normal lives - from work, to nutrition, to hygiene, to relationships, to sleeping and much more.
A fifth of the US population report that they suffer from chronic pain and often times that chronic pain cannot be explained by an obvious pathological connection such as a physical injury or emotional trauma that warrants pain signals from the brain. So, how does this happen? How can a human experience long-lasting pain when their body shows no sign of a problem that would naturally cause pain? We talked with licensed clinical social worker, Christina Philburn, with UT Health Austin’s Comprehensive Pain Management Clinic, about chronic pain, barriers and stigmas patients often face, and how UT Health Austin is treating patients experiencing pain differently.
Can you explain what is often happening in the body when someone suffers from chronic pain that is not occurring from a current trauma? At times, the neural pathway signals are being confused between nociceptive pain (an experience of danger from tissue damage) and neuropathic pain (which is incidental of central nerve damage), essentially causing a psychological alteration in pain transmission. This means your brain is telling your body that something hurts when really no threat is occurring. As much as our brains have the power to create a painful experience, our brains also have the power to identify when this is happening and figure out ways to reroute that energy and change the experience, but it’s not easy.
How does a previous trauma – physical or emotional – affect the presence of pain within the body? In some cases, patients have acute pain experiences that morph into chronic pain conditions due to lack of healing from other life experiences. In this way, the brain is reminding them to heal this trauma. For example, a patient may have been in a traumatic accident that both physically traumatized their body and mind. In this case, the injury serves as a traumatic experience developing into an acute period of post-traumatic stress disorder that may become long-term and although the physical or anatomic trauma may have healed the pain experienced by the mind is still there.
With the US opioid epidemic, many unfair stigmas have developed about pain and those suffering from chronic pain. What barriers do patients face in relation to the opioid crisis? There are many unfair assumptions people - including, family, friends and healthcare providers - make about chronic pain patients. For example, there are often misconceptions surrounding pseudo addiction, or the idea that patients are addicted to pain medication and they are attempting to exploit providers to obtain more pain medication. In reality, pseudo addiction is more commonly a person desperate for an answer to their pain which has been mismanaged in the past.
Common things I have heard from family members and providers are that these individuals have pain flare-ups in a way to “seek attention.” Also, that they are “just crazy” and their pain is “totally fictitious.” Which leads to assumptions around these individuals having low tolerance to not just pain, but all aspects of life. They are often wrongly accused of self-medicating, utilizing pain medications to address other emotional/cognitive pain, which leads to a notion that these patients are “too challenged” and already have disinterested attitudes toward treatment.
All of these misconceptions surface when other people are answering the patient’s own questions rather than simply asking the individual what they are experiencing, which includes empathy and vulnerability. These are important components to lessen symptoms and increase quality of life. The rigid thought of “if I can’t see it, I don’t believe it,” does not help when supporting these patients.
How should we as people and as a healthcare organization go about addressing the stigmas around people suffering from chronic pain? I believe it is essential to normalize and keep the conversation going. Through conversation and externalizing their experiences, individuals are teed up for success. Encourage safe processing any way possible! The concrete action of somebody voluntarily coming to your level and enthusiastically explaining how they want to be on your time no matter what, often increases self-efficacy and self-esteem.
The more medical providers normalize this model, the more the stigma evaporates. When individuals know that providers are willing to “walk through the trenches of their experiences”, the less embarrassment and shame they will feel because they are no longer walking alone. This walk together creates a successful road towards hope and recovery, both figuratively and literally.
How does UT Health Austin approach caring for patients with pain? Our team starts by receiving medical records from patients to assess their prior experiences with other pain related providers. At times, the social worker, will see the patient, at or close to, the initial medical assessment, to help the team with conditional logic of treatment. We meet as a team weekly to figure out what patients potentially should try certain pathways. The patient is involved in this conversation and they have a choice to participate in the proposed pathway.
Involving social work on medical teams provides a foundation for the team to better understand how psychosocial influences affect how well a patient progresses. For some patient’s getting to point A to point B, consists of a better understanding of themselves and the relationships within their lives. These relationships (personal, professional, spiritual) often parallel the relationship with their own bodies. Social workers emphasize the importance of mindfulness, empathy, and the power of mind-body connection when it comes to case conceptualizations and treatment pathways. Patients often feel more understood when their other needs are recognized and validated.