Their pain is never just one word
Opening Pandora’s Box
Asking patients about their pain experience can sometimes feel like opening Pandora’s Box. Unless you ask the right questions, it can be incredibly difficult to get the full context regarding someone’s pain. Even when they do open up, they might not give the full story, or they might go on and on. So, with limited consultation time, how can a health care professional (HCP) best explore a patient’s pain experience, to bring each individual sufferer the most appropriate, individualised pain management strategy? How can you maximise your time with your patients?
Better conversations for better clinical outcomes in pain management
The Global Pain Index (GPI), in its 4th edition, is a comprehensive survey comprising over 19,000 online interviews with people across 19 countries. The GPI provides valuable insights into the impact of pain on people’s daily lives, as well as how gender, age and background affect the pain experience. John Bell, a pharmacist, a member of the international multidisciplinary Haleon Global Pain Faculty, says, “How people deal with their pain, the experiences they have with pain, how comfortable they are in talking about it and what actions they take, of course, differ greatly.” For example, the GPI shows that one third of the world’s population are in pain every day, and one in five chronic sufferers are under 30 years old. In India, 83% of those surveyed felt that they could not be happy whilst in pain, and 82% of those surveyed in Poland felt that pain impacts their ability to enjoy life.
The GPI has also uncovered fascinating insights into the difficulties patients have when asked to talk about their pain. For example, 37% of sufferers agree that pain is still too much of a taboo subject to talk about. Furthermore, 73% of respondents in the GPI declared “I am tough, I can handle pain.” Thus, individual attitudes and societal pressures can alter a person’s willingness to speak about their pain. Wendy Wright, a US-based adult and family nurse practitioner who owns and operates two primary care clinics, elaborates by saying “we certainly know that culture can play a huge impact on someone’s willingness to talk to us about their pain. For instance, there are cultures where talking about menstrual pain is really considered taboo.”
Age also plays a role in how patients interact with HCPs and manage their pain. Bell mentions that generation Z “were far more likely to wait before they treated their pain and were far less likely to take medication.” So why do patients often delay their treatment or avoid going to HCPs altogether?
Globally, 56% of pain sufferers wait to treat their pain, whilst 9% do not treat their pain at all. Of the sufferers who delay, 16% will wait days or even weeks before seeking treatment. Importantly, patients who wait to treat their pain often suffer for longer (taking five or six steps to treat their pain).
Whether a fear of dependency or a preference for natural remedies, HCPs need to be sensitive of a patient’s fears and values when engaging with them in a conversation about pain.
Whilst getting patients to talk about their pain is to be encouraged, language is only one way that patients may give insights into their pain state. Dr Zubin Austin, a professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto, says that “Patients may not want to, or they may not be able to use words to actually express their current state of being. But they will communicate non-verbally through face movements, hand movements, through nonverbal cues…follow up and say things like, ‘well, you say you’re feeling fine, but you grimaced, you winced. You're clearly not feeling fine. Can we talk more about that?’” Dr Austin highlights that if you notice these important non-verbal cues, it can alert you to the actual intensity and duration of pain experienced by a patient. These non-verbal signals can also give important insight into how patients are coping, managing, and living with their pain.
With ever-increasing pressures on frontline healthcare services, enriching HCP-patient interactions can be challenging. Due to limited contact time with each patient, it can be hard for HCPs to obtain the information they need to make the most appropriate treatment recommendations. Yet, the time spent with an HCP can be the most important window to evaluate a patient’s pain.
Fortunately, there are ways to maximise time with patients, so that even the busiest HCP can gather the data needed to relieve pain efficiently. Bell gives advice on how to proceed: “We ask questions, appropriate questions, open-ended questions like ‘how is this treatment? How is it working for you? What kind of pain do you have? When is this pain worst? When is it better? What kind of things relieve your pain? What questions do you have for me?’ Importantly, open-ended questions like these are often effective conversation starters and will encourage many patients to begin to talk about their pain.”
On the other hand, Dr Austin talks about questions that could be avoided when talking to patients: “In speaking to patients about their pain, it is essential to avoid a style or a specific kind of question that attempts to suggest the patient is to blame for their current state… ‘Why did you go skiing? You're too old to do things like that.’” Dr Austin summarises “Anything that suggests that the patient themselves is responsible for their pain is not only disrespectful, but it also breaks the relationship between the healthcare provider and the patient and is going to lead to suboptimal outcomes.”
Thus, knowing which questions to ask, and importantly the questions to avoid, can help patients feel comfortable enough to talk about their pain.
Getting patients to open up about pain has never been easy. Societal and cultural taboos affect how patients talk about pain, even with professionals. Age, gender, and background also change how patients and HCPs engage. However, by acknowledging all of these factors, and asking the right questions, HCPs can reach out and open new avenues of conversation.
When asked what singular piece of advice they could impart to HCPs, Dr Austin replied: “Relying on your powers of observation and using your observations as a foundation for discussion can help patients to open up. And more importantly, it helps patients realise that they’re being seen, and they’re being heard.”
Let’s not be afraid to open Pandora’s Box. Neither you nor your patients can afford to keep pain locked away. With the right insight, patients don’t have to leave feeling that their pain wasn’t heard. They can leave knowing that you listened to their pain.
A helping hand from Haleon
At Haleon, we believe in making sure that every patient gets the optimal outcome they need to manage their unique pain experience. The #ListenToPain campaign aims to equip HCPs with the knowledge and tools to better understand their patients’ pain. Using information from the Global Pain Index, we’ve established five different patient profiles, describing their relationship with and the handling of their pain. Based on a deep understanding of the human pain experience, these five profiles can help you maximise those precious minutes with patients and individualise your approach.
We’re committed to providing HCPs with new tools and techniques, sharing the latest advances and bringing innovation that will allow you to better #ListenToPain.