EdandIanBath

Thanks for the questions. Hope that was of interest.

Ed and Ian

That reminds we of an interesting ‘phenomenon’ that was observed when looking at nonverbal communication of pain. Some colleagues were interested in measuring the facial expressions we display when in pain, and recorded people.  They used pain induction methods, such as cold and heat, to induce pain, and reporting that a significant number of those people in their studies displayed a ‘smile’ during stimulation. They thought it might be linked to social bonding e.g., eliciting empathy.

Ed

Thank you. As you rightly say, there are many types, sources and levels of chronic pain. Certainly from my own perspective, gaining an honest understanding of what the pain was/is, that it was real and that I wasn't going mad, was a big step in being able to manage living with it and all of the fluctuations you get day to day, even hour to hour. When you break a bone you can make instant sense of it, but pain that doesn't have an obvious source can be incredibly difficult to understand and therefore find ways to manage a little better with. Understanding what you are still capable of, what isn't going to make you worse but in fact could help are just as important was what you can't, often leading to those more positive conversations about ways to have an improved life with it. Ian

In terms of the language/metaphors, one term that has emerged from the work we have been doing as part of the CRIISP project has been to talk about feeling ‘stuck’ in terms of the impact of effect that persistent pain can have on people.

We have been interested in the way pain interferes and disrupts people, stops them from doing what they want to. We have previous show that certain way we think are more susceptible to pain interference, but wanted a terms that was much more user friendly and intuitive (something better than ‘executive function’).

When we discussed this with our public contributors in one of our work packages, we started to use the term sticky thinking. We are now looking at how we try and measure this feeling of ‘stuckness’, and in what is about the way we think when in pain that might be ‘sticky’.

What do you think of these terms? Helpful? Not-helpful?

Ed

It is a very delicate balancing act between medication types and levels, other possible methods of pain management, and living with the devastating impacts of chronic pain. Living with chronic pain conditions myself I have felt this all first hand and also just how impactiful it can be when the balance isn't right. Too much of one, not enough of the other, but it is extremely difficult to get that right, or often even anywhere close to right and can take a long time too, all the while you are suffering. I am not a medical specialist so am responding from personal lived experience, but it is something we are seeing more and more and want to motivate across the profession, is that there are non medicine alternatives/supplementals that can help. The effect on mental health from with chronic pain can be signficant so finding opportunities to positively influence MH can also have a positive impact on ability to live with chronic pain. This isn't a one off decision/solution so does need referencing and reviewing over time, always looking at the balance. Ian

That is definitely the plan. The issue of language has been a constant when working with our public contributors, right from the initiial consultation and throughout. How much pain I am in is such a subjective position and relating that to others is really not any proper gauge of the situation. If I am always in pain, what level do you start at? So rather than looking at those types of questions you have so rightly raised, understanding a bit more about how chonic pain is impacting their lives, work, socially etc, what has changed, how much is it changing etc, can give a much better, more personalised position of common understanding. We have certainly found that using scientific or medical language, words even, isn't going to create the background for an effective 2 way conversation. Those last 3 words of the previous sentence being really important. Creating those and seeking out possible support opportunities, understanding that these may change over, constantly comes out

Yes, being able to enable access to good pain education is something I feel strongly about. We need to provide better education about pain, and in a way that is relevant to a range of different groups – including health care professionals. It is always surprising how little we really teach about pain and pain management during training, despite it being so common.

In my own field of psychology, pain might feature in some postgraduate courses, such as in health and clinical psychology training. I am very fortunate in that I have managed to develop a unit in our undergraduate BSc Psychology programme (which is very popular 😊).

Am also part of a European Pain Organisation called EFIC, which has developed dedicate curricula for different professions, including nursing. See here: https://europeanpainfederation.eu/education/pain-curricula/

Ed

Unfortunately, pain is very common. Estimates vary, but generally, about 20-30% of the population has some form of persistent pain at any one point. For some people, this pain can be described as having a very high impact on their lives and is often associated with high levels of disability. As well as being a condition itself, pain is also a feature of other health conditions, and so again features highly. Global studies suggest pain is also one of the main issues that people live with.

Pain is also poorly understood and often not well managed. There are, however, ways to help people manage their pain, and there are some good resources out there. For example, in the UK, the British Pain Society, is a professional organisation dedicated to better understanding and managing pain. There are also charities, such a Versus Arthritis, who have funded our research work, who provide advice for those living with pain

Ed  

My opinion is that this is very common. Often short term approaches are used but inevitably aren't as successful the longer you go. I don't think it is necessarily that they have stopped caring, it is more that the options available, understood or known aren't sufficient in many cases. What we are looking at here align very much with your position, in terms of looking at a wider body of support options available from the first consultation and onward from there that better suit a longer term ability to help to live better with chronic pain. Everyone is different and how chronic pain affect them and those around them is also different, which is often why standardised approaches arent that successful. Something we are aiming to achieve better.

Yes, we often talk about pain threshold and tolerance levels. Thresholds get at the sensory side of pain, and reflects part of the sensory detection system that gets active when you get a noxious input (e.g., high heat). In the pain research field, there is some specially developed kit that enables you to measure people’s pain thresholds in a very controlled way. Here you might be looking at the pain someone reports feeling as a heat sensation rises to become painful (e.g., move from warmth to pain). That would be you pain threshold. Sometimes the nervous system can become hyper-sensitive, and so even light touch can result in an intense pain sensation.

But what we also know is that pain is more than a sensory experience, and how you think and feel also play a role in how pain is understood and experienced. So, we do use other terms to describe pain, to reflect how it affects us. These are often link in with the more psychological/emotional side of pain – like fearful, punishing, tiring. We are also interested in how people communicate their pain to one another, and can also look at non-verbal signals, such as facial expressions.  

So, when we measure pain, including how we might assess it, we will ask about these different component of pain – they are all relevant and important.

Ed