I will give up on this patient
And I will never believe that
Treating chronic pain is rewarding.
Deep down I know
The pain is all in their head
or
They are just using me for pills.
I will never believe that
My treatment plans will be individually tailored
“I have nothing left to offer them.”
I will never say
I look forward to treating chronic pain.
P.S. Read from bottom to top.
After reading this poem from top to bottom, the reader feels the frustration and fatigue of treating patients whose conditions do not improve despite medical intervention. When treating chronic pain, providers face an omnipresent temptation to believe that the pain is due to a behavioral health component, such as poor mood or anxiety. This leads to providers labeling chronic pain as “all in their head.”
The chronicity of a patient’s pain can lend itself to negative emotions and thoughts. This feeds into a perpetual cycle of negative thoughts exacerbated by pain refractory to treatment. This positive feedback loop only worsens as patients are referred to specialists and left feeling that they are not getting the upstream care they deserve. Conversely, given that only minimal improvement is common when treating chronic pain patients, providers (like me) may feel fatigued and as if patients “are just using [us] for pills.” The emotionally draining nature of these encounters and relationships can make it seem that treatment plans are failing and no end is in sight. Many providers feel they “have nothing left to offer” their patients. This can feel similarly burdensome for the provider as it does for the patients they treat.
In contrast to the blatant negative sentiments is the overwhelming positive message demonstrated by reading the poem in reverse. The reader now learns that key to treating chronic pain is embracing the challenge with as much positivity as possible. Although this may unrealistic for some providers, this has yielded the best results in treating my chronic pain patients. In my experience, the key to developing an “individually tailored” treatment plan is to understand the patient and their chronic pain story. Taking the time to strip back the multiple factors playing into their chronic pain (i.e., poor sleep, mood, social stressors, etc.) allows me to understand what my patients want and what plans may work best for them. This can be as simple as asking and understanding how pain affects their job or home life, or perhaps their thoughts on the pain medications they currently take. Patients with chronic pain want to be heard and believed. Although the pain may never fully resolve, having a provider that never “gives up” on them can be just as therapeutic as any medication or modality prescribed.
Image credit: The forest lake in midwinter by sunsju is licensed under CC BY 2.0.
Resident Physician Contributing Writer
Walter Reed National Military Medical Center
Ervin (Erv) is beginning his general intern year at Walter Reed National Military Medical Center and recently graduated from the Uniformed Services Univerity of the Health Sciences in May 2022. While in medical school, he was the co-director for the on-campus peer-led curriculum aimed to foster conversations about diversity, bias, discrimination, and inclusion in both medicine and the military. His interests include medical education, promoting diversity, and utilizing the arts to augment the healing nature of medicine.