It’s not just a number: Performing pain in healthcare

It really started on Monday, though I’d had twinges the week before. A slight ache between my shoulder blades while I worked. Not a big deal, I figured, and took some anti-inflammatories.

By the end of my shift Tuesday, that wasn’t the case. It was a constant burning pain. If I moved “wrong” – and wrong meant things like raising my arms, opening doors, or reaching behind me – it went from a burning sensation to an excruciating flash of pain. I had trouble moving around my house.

I’ve thrown my lower back out several times, so I upped my medication game a bit with the muscle relaxer my doctor had given me for just such an issue.

It didn’t really help.

So I didn’t go to work Wednesday, and since I couldn’t get an appointment with my normal doctor, I went to an urgent care.

The nurse practitioner who saw me barely did anything for me there. I think I know why. The same thing happened the last time I threw my back out and had to go to the emergency room.

I didn’t present properly to them.

I have a strange pain tolerance. An earache or sinus pressure will leave me moaning and curled up in bed. But I’ve walked on broken toes without hardly a complaint. As a teen, I broke both bones in my arm, and nobody believed it was broken until weeks later. And the last time I went to the ER for my lower back, I was pleasant and upbeat – because it was the kind of pain that hurts but doesn’t bother me in the same way, and because I knew how to hold still so it didn’t hurt.

The practitioner who saw me Wednesday had a similar experience. I kept my upper arms to my sides, so it was just that burning pain that I could deal with while I told her nicely that the pain reached a seven out of ten at times.

I didn’t have to open any doors or reach behind me or move wrong. I sat in the same place the whole time. She did not see me buckle for a second when I opened my car door as I left. She did not see me wince with every time I had to turn the steering wheel as I drove home.

Just like those times before, she undervalued my injury because my pain didn’t look the way she expected it to.

Maybe I should have reached backward. Maybe I should have not stayed in a position that kept my pain to a minimum. Maybe I should have done a performance of pain.

But I shouldn’t have to.

I sent a message to my normal doctor as soon as I got home; I’ve known him for over ten years. He knows about the times I’ve had a ten out of ten pain and what caused it. He knows that if I say I have a seven, I know what I’m talking about. I’m following his instructions (and staying at home, and resting) so that I can heal and not re-injure myself.

I’m lucky that I have that relationship with him and can get the care I need, because my experience with people underestimating my pain is sadly typical.

I know too many people who experience chronic intense pain, and are facing horrible problems because caregivers undervalue their pain, because caregivers are more worried about people misusing their prescriptions than making sure people can reduce their pain to a manageable level.

In the continuing education I have to do every year, there’s a whole section on pain. One of the questions that pops up every year is:

A patient tells you with a smile that their pain is a seven. Do you
* Record their pain as a seven and tell the primary caregiver?
*  Tell them they’re not really in that much pain because they’re smiling?

In the experience of myself and people I know, too many people mark the second, wrong, answer.

Believe your people when they report their pain. Don’t make them put on an act to prove that they’re in “enough” pain to take them seriously.

Don’t make anyone perform their pain for you.

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