Do Pain Management Specialists really listen to their patients?
Updated: Aug 26
When I started my career as a naturopath, I was enthusiastic to share my newly acquired knowledge to every client that walked through my door. I was keen to put people on the right track to wellness. Such lofty ideals probably apply to most of us entering a new profession.
Over 20 Years Later, I hope I'm a Wiser Clinician
The most important treatment I can provide is to listen. Yep, keep quiet. Keep my abundance of knowledge to myself. Hear every word of the difficulties that the client is experiencing and seeing their world.
Instead I ask:
o Why did you choose to come to me?
o And why now?
Talk Therapy for Chronic Pain Treatment - Who's Talking
Academic talk therapy has been around for hundreds of years, but therapists such as psychologists and counsellors need to beware of doing the talking - awareness for clients comes from client’s own thoughts. That "light bulb" moment when ideas, facts and information become a completed jigsaw, no longer just scattered pieces.
I recently had occasion to test my own therapy - in one of my meditation for relaxation. I'd painted an imaginary picture (in a clients mind) of a candle that could be any colour there choose. I then went on to explain that the colour surprised one clients as it wasn't what she expected!
When I asked for feedback later I was told that I had successful put a listener into a contemplative state visualising her candle. But, when I then talked about the colour my not be what you had expected she found "she was back in her thinking brain". This is important but challenging for the person leading the session, as it didn't disturb others in the same manner.
Finally, are pain management clinics and pain clinicians providing piecemeal advice rather than providing the glue to empower patients to fix all the jigsaw pieces in place?
Now here's the thing - of course the medical facts about your chronic pain are important. When I first started practice I had my list of questions. Ready to ask, which I did - 10 minutes of short answer questions, as found on examination papers. Who likes short answer exam questions?
Do Questions Encourage Patients to Talk About Their Chronic Pain?
Interestingly, in my postgraduate training in pain management that list appeared again, being given to experienced clinicians?
When did your pain start?
Where is you pain?
What makes it better?
What makes it worse?
What type of pain - burning, stabbing, dull?
How long have you had your pain?
Questions in this manner don't allow the patient to really talk, to tell the full-unabridged story of their chronic pain.
There is a range of communication techniques, taught by well-meaning lecturers.
o Active listening.
o Reflecting, such as repeating what the patient had just said.
o And probably more.
However, the best advice I heard was by Celeste Headlee, given on the TED talk, about how to really listen. She did have 10 pieces of information but there are three that really stand out for me and I believe are relevant here.
o Be present.
o Really listen.
o And importantly keep your ideas and comments to yourself-you are supposed to be listening to their ideas and comments.
Therefore how can we make plans to listen to our chronic pain patients or if you are a patient, what could help you tell your story.
Starting Questions to Show Interest in Your Chronic Pain
How about some open-ended question such as:
o Why did you decide to come and see me?
o What is it you are looking for? (but be prepared for "make me pain-free")
Patient's best experience is the joy of being heard!
Need for Case Taking Notes about Your Patient's Chronic Pain
So I've asked the open-ended questions. But then there's the problem of making notes. Finding a way to record the valuable information being shared. Again, the best advice I was given was to stop and ask, " Could I write that down?"
Not only did this give me time to record the information, but it also showed the importance of the information I'd just been given. Also 99% of the time the client gives me the space to write, quietly staying with their thoughts.
Unfortunately, the worse thing that happens in my opinion is the doctor sitting in front of a computer typing as you are sharing information. That important valuable information to you!
Do We Really Listen in a Conversation
One problem of "really listening" is of course how to record the important facts as mentioned above, but this is also a problem in general conversation.
Conversation is a two-way street, or it becomes a monologue and no one wants to sit and listen to a monologue. A conversation needs balance between talking and listening. However it is your pain and you as a patient should be given time to describe, the impact on you and your lifestyle, and at the same time you want answers from your doctor.
The open-ended questions mentioned above often do get patients talking and unfortunately moving away from the information you need. But there is an easy, smooth way you can gently steer the conversation by saying
"You mentioned your pain was helped by...?"
A final word about body language another area of training offered to practitioners. Just keep it simple. Look interested, look like you're paying attention - which your are! Can include the occasional nod and ahah.......if you really heard!
Conclusion - Inspired by a Not listening Problem
I dedicate this article to a long-term client who I now call friend who moved from Australia to retire in Spain. He inspired me to write this article, although he's completely unaware of this. After living in Spain for 5 years, he now has a vocabulary on his computer of 30,000 Spanish words but not yet able to converse fluently with the locals.
If you are having problems learning a language then one thing to check is how good are your listening skills in English? Listen to a person talking or something on TV, stop and repeat the last couple of sentences word for word. If you cannot do this or what often happens your mind is blank - you are not "really listening". You are more than likely thinking about what you want to say.
Might be time to practice your listening skills.
Celeste Headlee: 10 ways to have a better conversation. TED Talk
Want to find simple effective ways to reduce your chronic pain (change for each blog/topic) without increasing your stress and overwhelm? This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques. After over 20 years of having my own pain clinics pain clinics I started natural pain solutions to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home. Learn more about me here.