No pain IS a Gain: helping clients work through medical decisions while staying in my lane

dinos and comics

As a movement teacher and an educator, advising on anything medical is beyond my scope of practice. However, since starting my course, I now have tools to help my clients advocate for themselves. Where once I would be sympathetic to a client’s sense of being dismissed and having to fight to be treated - or being unable to get past “gate keeper” receptionists to even be seen. Now I have the confidence to inform them that pain is the fifth vital sign and that it is a human right that they be treated.

Many of my clients have pain stories that follow recurring themes. After cascades of medical interventions they are living with more pain than the initial discomfort they felt to start with. They have been seen by multiple doctors for multiple conditions who all provide conflicting advice. They are given unhelpful and false statements by doctors such as “bone on bone.” On top of this we have all heard stories of surgeries that have been retrospectively harmful, be they for breast implants, metal hip replacements or vaginal mesh. This means that the prospect of surgery, or any medical procedure can be very worrying for them.

A useful framework that they can talk through with their doctor is the B.R.A.I.N informed decision making tool. I came across this tool in my essay research around medical ethics, I now use it all the time.

“B” stands for benefits and asks what good will come from this procedure? When compared with sham/placebo surgery how has this one fared?

“R” stands for risks and requires a conversation about present and hypothetical risks as well as side effects and long term safety.

“A” asks about alternatives and complementary therapies that they can follow alongside a treatment regime.

“I” asks what one’s intuition tells them and asks what decision feels right to them.

“N” asks what will happen if I do nothing? What if we take a pause on this course of treatment?

Initially the benefits to a course of action may seem obvious and though Google can be a harmful rabbit hole, a useful site that I can direct people to is StatPearls in google scholar which is a free library of medical information. Here someone can find out about their medication or surgery without the background noise of opinion and bias. I have been using it in my course to get reliable information about medication mentioned in lectures.

The figure below shows that post operative pain may actually last for months after an operation. Again this is something that I've only come to learn about in research for my Acute Pain essay. Before surgery I would want my client to to know their doctor’s peri-operative pain management strategy; their opinion on alternative treatments; and on what the outcomes for doing nothing could be.

The graph below shows the number of people, with moderate to severe pain, that need to receive a treatment before one person feels at least 50% pain relief over 4-6 hours. What the concept of number needed to treat (NNT) shows is that not all analgesics work on everyone, and they do not need to eliminate pain entirely to be seen to work. Though doctors know about NNT, I didn't know what this was until I started my course. To put one’s faith entirely in medication is subscribing to the belief that pain is purely a biological experience. This is where alternatives and complementary services can help someone. Yes, they need to see a doctor but they may also need to see people who can help them with movement, meditation, visualisation, breath work, mindset training and pain education. They might see a therapist, a sleep expert, a nutritionist, an in person pain support group, online pain support and a specialist pain clinic.

This image here shows natural remedies for pain that people have used for centuries. Most of my clients use one or two of these "old wives tales." Through my learning this year I have discovered that there is some scientific backing behind traditional remedies and more importantly - if my client believes that it will work, then it probably will thanks to the power of the brain and the placebo effect in its role in pain reduction.

At the heart of the Hippocratic ideal is the concept of “doing no harm.” A doctor must surely feel that in doing nothing they are failing to intervene and they are not doing their job properly. It is through weighing up side effects, complications and long term effects of a treatment with their patients that they come to the right decision. However, it is the patient’s right to decline treatment. As long as they have the capacity and understand the risks incurred through not having the treatment their choice must be respected. I have a client who has had two back surgeries already and is living with chronic pain caused by the surgeries, she is sure that one more surgery will fix her pain. I have asked her to talk through these questions with her doctor. I have also asked her to get a second opinion.

As I am introduced to the medical side of the pain world, I feel that I can support my clients through giving them questions to ask their medical professional while supporting them holistically in the psychological and social components of their pain experience. I understand how useful my work is as a component in their recovery process.

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