Ep 11. What’s the Harm?
Trigger warning: This episode deals with the topic of suicide.
Dan and I have an interesting and important discussion that bridges the gap between patients’ clear and obvious frustrations with how different versions of “it’s in your head” affect them and providers’ lack of awareness around the issue. How can this be the case? And how does being told pain is in your head possibly increase suicidal thoughts by 500-1200%? We explain how it occurs and compare it to what we’d accept from other therapies.
Chronic pain patients have a 25% likelihood of suicidal thoughts in the last 2 weeks. If how we explain pain increases that risk in as few as 5% of patients, we might need to think of another explanation.
If you are a patient who has had suicidal ideation recently, please reach out to one of the below suicide support lines in the show notes. We need you.
Introduction
This episode of "It's Not In Your Head" podcast, hosted by Dr. Dan Bates and Justine Feitelson (Dan and Juz), explores the potential harm caused by telling chronic pain patients that their pain is "all in their head." The hosts delve into the consequences of this approach and its impact on patient care and outcomes.
Key Points
The Harm of Dismissive Language
The phrase "It's all in your head" can be deeply damaging to patients with chronic pain.
This dismissive approach can lead to a breakdown in the patient-physician relationship.
Many healthcare providers may not realize the negative impact of such statements.
Underreporting of Harm
Harm due to psychological interventions is rarely reported in medical literature.
Studies often focus on physical adverse events rather than psychological harm.
Patients frequently experience flare-ups during exercise interventions, which may go unreported.
Impact on Patient Trust and Hope
Patients with unexplained medical symptoms often feel they are not taken seriously.
This can lead to feelings of being accused, labeled as crazy or lazy, or viewed as manipulative.
The resulting loss of trust and hope can have severe consequences for patient well-being.
Increased Risk of Suicidal Thoughts
Chronic pain is associated with an increased risk of suicidal thoughts or behavior.
Hopelessness, a common result of dismissive treatment, significantly increases suicide risk.
The risk-benefit ratio of certain interventions may not justify the potential harm.
Neurological Basis of Pain
Chronic pain involves neurological changes in nerves, nerve roots, spinal cord, and possibly the brain.
Understanding pain as a neurological process rather than "in your head" can be more helpful for patients.
Better Approaches
Recognize the neurological changes involved in chronic pain.
Avoid dismissive language and focus on explaining the complexity of pain mechanisms.
Emphasize that all pain is real, regardless of its origin.
Provide education on the role of the brain in pain generation and maintenance.
Use a collaborative approach to gather evidence and help patients understand their pain.
Conclusion
The episode highlights the critical need for healthcare providers to be aware of the potential harm caused by dismissive language and approaches in treating chronic pain. By understanding the neurological basis of pain and adopting more empathetic and educational strategies, providers can better support their patients and improve outcomes.
Episode References:
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