For this week I decided to skip the questions I have been asked recently and focus on an event that happened to me this past week.
I have a patient that came in to see me for pain control. The patient has had a rough few months after being diagnosed with cancer, undergoing chemotherapy and then developing shingles on top of it all. She and her husband have struggled to find a way to give her relief from her pain and the distress all these events have caused.
We mainly talked on the first visit and I proposed something to her that seemed almost too difficult for them to believe. I said that I was sure she would feel better. I said there was no way for me to be certain if her pain would go away completely, but I was sure that the intensity of her pain would be better.
This is not the first time I have stuck my neck out there to make such a bold statement, but for me it is grounded in fact more that fantasy. I readily admit that I am not the smartest therapist out there and having met a lot of very intelligent and gifted medical practitioners I have come to realize that I am not as smart as a lot of my colleagues. What I will say...to pat myself on the back...is I am good at the obvious and the basics.
This may not sound like it is all that impressive, but I have to toot my own horn for a minute and say that I have built my career around this type of therapy. I have found that the vast majority of people have straight forward and basic conditions that match common sense and basic physiology.
I think because in modern society there is information overload and certainly dramas on TV have huge audiences tuning in to the shows that highlight the rare and extreme case scenarios because they are far more dramatic and entertaining. I myself enjoy those shows and certainly read almost daily about the medical research in the news and in the journals I subscribe to.
For me I have stayed true to the basics and I have toned my skills to notice the basics and ask questions that confirm or deny my working hypothesis. So when I boldly told this couple that I was sure her pain would improve, I wasn’t offering false hope, I was playing the odds and following physiology and in particular the adaptability of the body and brain.
This woman’s pain would improve without any intervention because pain is merely an impulse that goes to the brain for interpretation. Initially the brain interprets the events as “BIG” impulses and the intensity of the pain is high. As the repetition of the impulse comes in there is a dulling effect...in most cases...that leads to less pain.
I also asked the basic question if she was able to fall asleep at night, even if it was momentary. To which she said yes. So now I had proof and direct evidence for her to use in the future. The fact that she experienced sleep means that somewhere along the way her brain/body figured out a way to block her pain long enough for her to fall asleep, and while asleep she had no pain.
For me I like to “prove” something is true or not true. Very few things are “100% true” which means there is an exception. So when she tells me that she “always” hurts I find out what happens when she falls asleep and I learn she has no pain. This means that she doesn’t “always” hurt. Which means her body/brain is already working on a solution to reduce her pain.
I think it is important to bring this up because a lot of the time we get stuck, so to speak, where we believe something that is only partially true. This leads to frustration and our focus narrows so we struggle to find solutions.
In their desperation to find relief the couple has focused only on specific concepts and treatments and unfortunately they did not help. By focusing on the basics I was able to start the process of guiding her to a reduction in her pain. “I” am not going to do anything to help her, other than guide her back to what her body has already shown her.
My job to the guide, I have the “basic” plan and for most it is a good place to start. If the terrain becomes complicated then at very least the “basic” plan has clarified what it “CAN’T BE.” And sometimes when we are dealing with debilitating conditions that is not only the fist step but it is the only step needed.
If you have been dealing with a lot of pain there is hope and relief is available. I don’t say people will be pain free because #1 it may not be realistic and #2 pain is not the enemy it is merely pointing you in a direction and those individuals who truly feel no pain usually die young because the help we all get from pain is not available to them. So just like the couple I can boldly say that the intensity of pain will decrease with time and if you are stuck, find someone to guide you through the process of feeling good again.
