“It Could Be Worse” and Other Things to Avoid Saying to Your Patients With Chronic Pain

Opening the lines of communication with your patients with chronic pain and discussing times when they may have felt that you, as their clinician, did not understand their pain can be integral to better treating their condition, according to Melissa E. A. Geraghty, PsyD.

Dr. Geraghty, a health therapist who works in a private practice in Naperville, Illinois, explained that so many people in the life of a person with chronic pain say things such as, “It’ll get better” or “It could be worse.” As their clinician, avoiding the use of invalidating language is crucial to understanding and managing the pain experience.

“For most people, it is extremely uncomfortable to acknowledge all that a person with pain deals with. So instead of truly listening and allowing persons with pain to express themselves, people often rush to speak words of comfort or advice,” Dr. Geraghty said. “This can be very invalidating as it does not allow the person in pain to feel that he or she is being heard.”

Dr. Geraghty noted that there are two highly effective tools available to help clinicians better communicate with their patients.

The first tool is the clinicians themselves.

“Clinicians should immerse themselves in the pain community in ways beyond the standard expectation of reading pain-specific journal articles and receiving pain-based education— although, of course, these are very important as well,” she said.

Clinicians can further immerse themselves through peer supervision, consulting pain advocacy websites, and participating in patient forum websites to learn more about the patient perspective.

The second tool is the patients themselves.  Dr. Geraghty reports that the best form of communication is truly listening to patients and not just waiting for the opportunity to speak.

“Show a genuine interest in learning how conditions affect patients individually instead of placing them in a standardized box,” she said.

In discussing pain catastrophizing, Dr. Geraghty offered this pearl: “If you suspect a patient is catastrophizing, do not assume that all of what he or she is saying is being overexaggerated or representative of a psychiatric diagnosis.” She explained that it is important to use open-ended questions in a supportive manner, such as: “Tell me more about what you mean when you said you felt like you were dying during that intense pain episode.”

She said it is also important to avoid stereotyping patients, because “preconceived stereotypes can influence questions asked by healthcare professionals and thus influence diagnosis and treatment planning.”

The most important facet of treating patients with chronic pain is setting up realistic expectations, she said.

For many people with physical disabilities, their condition will likely worsen due to age and/or new medical difficulties, even if the disability itself is not considered progressive.

She urged clinicians in attendance: “Do not present statements full of false hope such as, ‘I’m sure they will find a cure soon’ or ‘I’m sure it could not get any worse.’ ” Engaging patients in their care and setting realistic expectations and attainable goals will help patients to become more active participants in the management of their condition.


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