Pain Science and Narrative Medicine
For the past two weeks, I’ve been in the company of greatness. From San Diego’s Pain Summit to NYC’s Narrative Medicine Conference, I’ve had the honor of learning from some of the brightest minds in health and humanities. Joletta Belton does an incredible job of polishing the Pain Summit gems here: https://bit.ly/2NMUAa3, so I’ll spare you a less impressive recap. As the Pain Summit and the Narrative Medicine Meetup simmer together in my mind, I can’t help but think: perhaps they were meant for each other?
Here’s the gist of it: stories matter. The stories we are told by our doctors, the stories we tell each other, and the stories we tell ourselves are the foundations of our lived experiences. As research has shown time and time again, pain is less about a physical wound than it is about meaning. Trauma will often result in pain, but how we perceive that trauma— as a livable challenge or a degenerative process, as something that conquers us or something we can manage— is the most reliable predictor of pain intensity. As I learned from Katie Schopmeyer’s brilliant talk on pain assessment practices, “The single most effective pain reliever is self-efficacy (the sense that one can manage and everything will be alright)” (Mariano E. Menendez, MD). So, when a doctor tells patients they have degenerative disc disease (a diagnosis almost synonymous with aging, and a poor predictor of pain from an MRI standpoint), patients are likely to hear the words “degenerative” and “disease” and assume their pain is only going to get worse with time, despite their best efforts. On the other hand, Mark Bishop’s excellent talk on placebo demonstrated an undeniable correlation between a patient’s expectation of improvement and the eventual outcome that he or she improves.
Ultimately, pain is about meaning, belief, and context. But let me be clear: this is not to say that you can simply believe pain away! As I’ve learned from countless folks in pain who still lead full and rich lives, pain might persist for a lifetime– but pain does not always equal suffering. To put it another way: Pain + Acceptance of Pain + Belief in One’s Own Innate Ability to Cope= Pain Management. And the more movement and connection we practice, the more likely we are to experience pain relief. I have a hunch this is what I’ve been doing as a manual therapist all along: providing a safe space for movement, a reason to hope, and a companion for the journey.
…Which brings me to Narrative Medicine. According to the Columbia University program webpage, “Narrative Medicine is an interdisciplinary field that brings powerful narrative skills of radical listening and creativity from the humanities and the arts to address the needs of all who seek and deliver health care.” But to borrow from the wisdom of NM alumna Lissanthea Taylor, Narrative Medicine is, quite simply, a practice. Through close reading, we practice mindfulness and attentive listening. Through creative writing, we practice self-reflection and acceptance of imperfection. And by sharing our writing, we practice vulnerability and connection. Together, these practices allow us to hold our beliefs up to the light, to transform them if they need transforming, to accept them if they need accepting, and if we’re lucky, to find new meaning and belief in each other. At the Pain Summit, yoga therapist Shelly Prosko mentioned several great studies linking meditation and mindfulness practices to pain relief; I’d bet my bottom dollar there’s a positive correlation between Narrative Medicine practices and pain relief too.
As Amy Thompson so aptly puts it, Narrative Medicine challenges health professionals to bring their “full humanity to the table.” In the afterglow of these incendiary conferences, I find myself wondering if that table might be big enough for folks outside of the health profession as well. Is this field capable of expanding beyond the clinic to serve, not just “all those who seek and deliver healthcare,” but all those who are capable of suffering? And truly, who would this exclude?
After years of feeling torn between the two, I’m finally excited to have one foot in medicine and the other in the arts, and to see those fields slowly merging. Art has always been and always will be a lifeline to our humanity. Art has always been medicine. If you’re curious about Narrative Medicine and you’d like to join one of our monthly meetup groups in Austin, email me for details. I’m especially interested in forming a group for those managing chronic pain and chronic illness, so please don’t hesitate to reach out if you’d like to be a part of this evolving practice.