Pain Behaviors Can Perpetuate Stigma
Pain behaviors are all the things people naturally do when in pain. Yet these very legitimate behaviors are some of the excuses people use to blame patients and accuse them of lying. In short, pain behaviors can perpetuate stigma.
Cultural expectations of expressing pain
Now I don’t know about you, but there is only so much pain I can take before I can’t help but to cry out, groan, or scream. If my back hurts, I will arch it. If I sprain my ankle, I will limp for awhile. These things happen unconsciously. There are also cultural and familial influences on how we express pain. Some people are stoic while others wail loudly. These are simply differences in pain expression. Our cultural expectations also influence how we perceive others who are in pain.
The term, "exaggerated pain behaviors"
Several years ago I worked at a community mental health center as a case manager. Part of my job, when I was assigned a new client, was to review their chart to familiarize myself with their history. This is where I first encountered the term “exaggerated pain behaviors”. Looking back, I wonder about the qualifications of those who wrote these notes. Most of the staff members were unlicensed with at most a bachelor’s degree in social work or psychology. About 1/3 were licensed social workers and therapists and maybe 6 or 7 nurse practitioners and 1 psychiatrist. Nobody specialized in chronic pain management.
Learnings from counseling training
At the same time, I was enrolled in graduate school, earning my Master’s degree in Counseling. I learned a few of things that made me question the validity of the term “exaggerated pain behaviors”.
- Professionals should develop mutual trust with the client or patient. If you can’t trust your client, you should refer them to someone else.
- People will behave (unconsciously) in ways that get their needs met. I was taught to pay attention when people ask for help and believe them, not to suspect them of exaggerating.
- A person’s culture, history, and environment will determine the way in which they ask for help. Some people are stoic in the face of pain while others complain loudly. That doesn’t mean either one is “faking it.”
Misinterpretation of pain behaviors
It seems that pain behaviors are easily misinterpreted. What is a legitimate expression of pain to one person may be an exaggeration to someone else. While it would be nice, there is no test that can determine the presence and/or severity of someone’s pain.
It can be uncomfortable to observe someone else in pain. Many people don’t know what to do with that feeling. In the face of something that cannot be fixed, most people walk away. It takes a special person to be with someone who has incurable pain.
I can understand this concept and still not accept stigma. It’s one thing to do nothing. It’s quite another to attack, blame, and shame the patient. We need to talk about the real pain behaviors of migraine patients. Society has learned to expect we will take medicine, use ice packs, and find a quiet, dark place to rest. Great, but that’s only a fraction of our typical pain behaviors.
What kind of pain behaviors do you exhibit during a migraine?
Do you think those behaviors are well-understood?
How can we change the way people interpret our pain behaviors?
My dark room: