An Anatomy of Pain by Abdul-Ghaaliq Lalkhen

Author:Abdul-Ghaaliq Lalkhen [Lalkhen, Abdul-Ghaaliq]
Language: eng
Format: epub
Published: 2021-02-02T00:00:00+00:00

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The consultation starts with my walking out to the waiting room to receive a patient. I pay attention to who they are with and how they are walking. I can tell a lot about somebody simply by the way they walk and carry themselves. I usually invite partners into the consulting room, but sometimes the patient tells them to remain outside, and the reason for this often becomes clear over the course of the next hour. If I am with a physiotherapist, they spend some time explaining the role of physiotherapy in pain management. Then I usually summarize the results of the questionnaires the patient has completed. I have found that being able to recite details about their lives and the answers they have given gives them some comfort and makes them feel understood and listened to. And it can help build rapport. Not being listened to by their previous healthcare professionals, particularly doctors, is a major complaint of patients who attend our pain clinic.

I usually have to explain what our pain clinic offers, particularly to patients who have been to other pain clinics. I did this with Diane. I started with an explanation about chronic pain and how our belief is that the pain is due to changes within the nerves and how they function rather than due to ongoing damage. I talked about the fact that patients who have had limbs amputated continue to experience pain even though the limb is no longer there and therefore cannot possibly be damaged; the pain is still experienced because the nerve that used to go down to the limb is still present, traveling from the stump to the brain. I explained that it was very difficult for us to stop these abnormal sensations and that our pain clinic worked with people to help them live productively with the constant presence of pain rather than trying to attempt to cure the condition. I sometimes adopt this approach with patients who have a long history of persistent pain and who have had multiple negative interactions with clinicians. Clarifying the clinic’s position at least gives the person the option of walking out or, hopefully, allows them to manage their expectations at the outset.

The history taken during the consultation is largely an attempt to understand the person and how they and their loved ones live with chronic pain. By the time they reach the pain clinic most serious conditions have been excluded. There are many pain consultants who argue that they are not diagnosticians and that they cannot be held responsible for missing pathology. A couple of times in the past decade I have found cancers of the spine, but in these cases the patients presented with pain and risk factors that made it patently obvious that there was something else going on. Most patients have had a thorough evaluation prior to coming to the pain center, and it is usually very clear that we are dealing with a chronic nonmalignant pain condition.

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