Murray J. McAllister, PsyD
Murray J. McAllister, PsyD, is the editor and founder of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.
There’s a divide between chronic pain experts and their patients that rarely gets crossed. The divide centers on the issue of fear-avoidance of pain.
At first thought, it might seem crazy to accept that your pain is chronic. When I bring it up with patients, many of them tell me, not without irritation in their voice, “I’ll never give up hope of finding someone who can fix me!” Indeed, it’s common to think that accepting the chronicity of your pain is the same thing as giving up hope that you’ll ever get better.
Half jokingly, patients with chronic pain can sometimes start to wonder whether they are coming down with Alzheimer’s. They don’t seem to remember anything anymore. Besides memory problems, it can be hard to concentrate, multi-task, and find the right word to use – that experience when the word you want to use is “on the tip of your tongue.” People with fibromyalgia have even given these problems a nickname – “fibro fog” – as in when your head is in the clouds.
In the last post, we addressed the question, “Why see a psychologist for pain?” The answer is that psychologists are the experts in teaching patients how to self-manage and cope with chronic pain. Patients who see psychologists for chronic pain can learn to self-manage and cope with pain so well that they can largely come to live a normal life despite having chronic pain.
Patients can sometimes question why their physicians want them to see a psychologist for pain. The concern, of course, is that they are going to get stigmatized. They might wonder, “Doesn't my doctor not believe me?” or “Do they think it’s all in my head?” This reaction can often prevent patients with chronic pain from seeking the care of a psychologist. It is, however, unfortunate. Among all healthcare providers who specialize in the treatment of chronic pain, psychologists provide some of the most effective therapies.
In the last post, we started a discussion about how people cope with chronic pain really well. Specifically, we looked at five attributes and skills that people do when coping well with chronic pain. The point of the discussion was that it is a way to learn how to cope better. Coping with chronic pain is a set of skills like any other set of skills and you learn how to cope with pain just like you learn other skills – like learning how to knit or play the piano or play tennis.
If you wanted to learn how to knit well, you might take a class at your community craft store. You might also get a how-to book out of the library or watch a few YouTube videos. But as you did all these things, you would also pay attention to those who already knit well and watch how they do it. You would then try to do what they do.
I recently came across this blog post in my reading and thought that it would be a good conversation starter. In the post, Mark MacLeod, MD, raises the point that we need to have an on-going discussion about values in healthcare. Dr. MacLeod is on to something here. In his piece, Dr. MacLeod is writing within and about the Canadian healthcare system. However, his point is applicable to any country’s healthcare system. We need to engage in a communal dialogue about our values when it comes to what we should (or should not) do with our healthcare systems.
Thomas Kuhn, a historian of science, popularized the notion of a scientific paradigm in the second half of the 20th century and since then almost every significant change in a field of study gets characterized as a paradigm shift. So, it is a bit of a cliché to talk of the paradigm shift that is going on in the field of chronic pain management. Nonetheless, it is true. We are actually witnessing it happening.
If you have chronic pain, you also have to deal with stigma. Stigma is the disapproval by others for how you are coping with pain. Friends, loved ones, employers, and even healthcare providers can judge you in any number of ways. They might disapprove when you rest or nap, or if you don’t work, or if you take narcotic pain medications. Such critical judgments from others are stigma.
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