Ready to engage with people living with pain in a creative way?
I like to think that with all the courses, blogs and content on social media out there, clinicians have a better understanding of language use, creativity and communication skills. Well, you might think that but then your likely mistaken. There’s still much to do when it comes to building a therapeutic alliance with your patients and having a number of ways to reframe pain is certainly an advantage.
We all have a fear about not providing the right information to our patients, sometimes we might feel under-prepared or inadequate to talk about difficult and complex issues, particularly when it comes to pain.
So to help you with your communication here are 7 creative ways to reframe pain.
The slides are not in any particular order, they are just a collection of images I use on a day-to-day basis.
You are welcome to use these slides with your patients provided the source of the material is referenced.
PAIN IS = Socratic discovery about a person’s pain
This image helps to open up socratic collaborative dialogue with your patients. Ask the question:
What does pain mean to you?
All responses are valid as pain is a subjective experience. It helps to highlight the complexity of pain, the strange sensations, the thoughts and emotions and the difficulty of explaining what people living with pain are going through. It helps to connect with people at a deeper level.
Further questions you might want to ask are:
What do you understand it is?
How does it make you feel?
How do people respond to you?
See the bigger picture = Scans don’t tell you the full story
This image provides a creative way of helping people understand their MRI scans and to consider the bigger picture.
By zooming into one aspect of the image (small cut out on the left) it tells you very little about the overall picture. We naturally make assumptions about what it could possibly be. If we then zoom out and see the image for what it truly is it tells us so much more. MRI’s don’t provide a true picture of why someone is experiencing pain.
Caravaggio vs Picasso painting = Explaining smudging in the brain
This image is useful with patients to describe the “smudging” effect that can happen in the brain with pain. Ask the patient to compare the details in the Caravaggio painting right down to the definition of the fingernails on the hands of the boy. This is what the sensory part of the brain “sees” when it is firing on full strength. Then ask the patient to compare the Picasso painting where the outline of the body is much more difficult to make out. Everything seems to be obscured and you can’t make out the exact outline of the body. This is what happens in your brain when you have a persistent pain situation. The brain can’t seem to make out a clear representation of the that part of the body and may explain why the pain seems to “move around”.
The Devil and his Minions = Pain has a mind of its own
Pain (devil) he’s a crafty little beggar! Pain can often have a mind of it’s own, stopping you from doing things around the home or with friends or family. It almost seems like he has control and boy does he let you know about it when you do too much. Sometimes his minions can be around your body giving you a sharp stab when and where you least suspect it. This can help to explain the randomness and spontaneous pains that can occur.
By regaining confidence and building your tolerance you can slowly take control of the devil and reduce him to the annoying little pest that he is.
The Dark Room = Dealing with painful movement
Dealing with painful movement is a lot like getting out of a dark room. Standing up and running with the hope that you end up outside of the room is probably just going to end up with you hitting a wall. On the other hand, you can’t just sit in the middle of the room without moving. If you want to get out of the dark room you’ll have to explore. You would get up and carefully feel for a wall and then gradually feel around until you came to something familiar like a light switch or a door.
If you just ignore the pain and go hard, you’ll probably hit the wall. At the same time, if you avoid movement altogether, well then you aren’t going to get anywhere. You have to thoughtfully explore the edges of your available movements, looking for opportunities for expansion. However, the doors are stuck and may even be locked. This is like chronic pain where an exit door has proven elusive. It doesn’t mean it’s not there, but it’s not likely to be found or opened quickly.
The Pain of Command = Coupled habits or associations
The brain is always looking out to protect you and because it is so clever it helps us to form coupled habits or associations which essentially makes us more efficient in our daily lives. In some situations associations are formed in order to protect you. There is where the brain controls the Pain of Command.
If we have certain beliefs about a moment say bending, we may couple or associate pain with that movement and hey presto a habit is formed! Any activities that involve bending no matter how small the object is we are likely to adopt specific behaviours. In this case keeping our back straight when lifting all objects light or heavy to avoid bending and feeling pain.
We can use Graded Exposure to uncouple the beliefs that are associated with certain movements or activities.
In times of crisis be prepared = how to manage flare ups
Earthquakes, they are pretty unpredictable, they can be weird and variable. They can be invisible and have a level of uncertainty to them, most seismologists would say they are pretty complex. Hmmm, those words look familiar? Funny that! At times of a potential earthquake it’s important to be prepared. People are advised to buy an Emergency Survival Kit, which might contain flares, silver blankets, food rations, face masks and gloves and other stuff to hep you live through the crisis. This is a metaphor to help people make comparisons to pain flare ups. Help people living with pain be prepared by discussing what they can put in their Relapse Response Kit.
A few examples might be: Mindfulness, gentle activity, medication, a hot water bottle, distraction, chocolate. Try and avoid poor coping strategies such as alcohol.
This blog is just a few suggestions to which there are many many more! I want to help everyone get their creative juices flowing! Try making up your own. You are welcome to adapt the slides above to facilitate your delivery to the various social constructs of your patients.
If you decide to use them or adapt them please remember to reference the source of the material. This blog is to be made into a short ebook in the coming weeks.
Please feel free to share any comments you have.
Thanks for having a read
Thanks goes to the contributors of this blog.
Mike Stewart @knowpainmike
Cory Blickenstaff @ForwardmotionPT
Karen Litzy @KarenlitzyNYC