Building knowledge about pain
Helping patients to understand more about how the brain affects their experience of pain is a crucial way of shifting the conversation away from the medical model towards person focused self-care.
Your role is to guide the patient to realise the need to shift from trying to “find and fix” the pain to “managing and living a valued life” despite the pain. To do this it may be useful to start by:
- Hearing the pain story from the beginning (particularly if the patient is new to you).
- Reviewing the notes to ensure that the medical investigations and treatment are optimised.
Once you listened to the 'pain story' you can then help the patient to understand that is it time to change the agenda by taking the action and using the resources described below:
Action to take
Share knowledge about pain and the brain
Use the pain and the brain sheet (see below) to explain the role of the brain in chronic pain. Explain that is it is possible to help the brain to manage pain better, for example by addressing sleep difficulties.
Offer the Explaining Pain leaflet (see below) or provide links to videos such as Brain man. You could suggest that the patient looks at the information before the next consultation and picks out what they would like to talk through. This may help the discussion about what persistent pain means for them now.
If you are not sure how to explain chronic pain to your patient, you may find these explanations useful:
If you are inexperienced in doing this, consider asking a colleague to role play having this conversation.
Consider video recording yourself in consultation so that you can observe your own and patients’ reactions.
Help the patient understand the need to 'change the agenda'
Talk to your patient about focusing on things that can be changed, rather than focusing on the pain which is the least changeable.
Download and print the pain cycle or iceberg resources (see below) to look at with your patient. Exploring these resources together will provide opportunities to open up the conversation and discover areas where they would like to see changes in their lives.
Resources for your patient
Pain and the Brain
Many people have a very simple, even simplistic, way of thinking about how and why pain occurs. While this works fine in many day-to-day situations, it falls down when trying to understand longer-term, or persistent pain. This A4 sheet has been designed to use in consultations with your patient, to help them think about the many factors that are contributing to their experience of persistent pain.
Pain is like an iceberg
Persistent pain is like an iceberg – there’s so much more to it beneath the surface. This poster shows the impact pain can have over time. Use this with your patient to identify three things they would like to change in their life.
Flippin’ Pain website
Flippin’ Pain is a public health campaign, with a clear goal: to change the way people think about, talk about and treat persistent pain. Their website has some very useful information to help patients understand more about their persistent pain.
Understand Pain in Under Five Minutes
A great little video to share with your patient. Does what it says on the tin.
There’s an awful lot about persistent pain that people don’t understand. This booklet, aimed at patients, explains:
- what persistent pain is
- what is going on inside us when we have persistent pain
- why people develop persistent pain in the first place
- how it makes us feel and what we can do about persistent pain
ICD 11 Classification of chronic pain represents chronic pain as a disease in itself. Chronic secondary pain is chronic pain where the pain is a symptom of an underlying condition.
Building knowledge about pain
Summary of key points
- An understanding of the relationship between persistent pain and the brain is essential to shifting the conversation away from ‘find and fix’ to living well with pain
- It will give you and the patient confidence and guide their journey to live well with pain