Arts can spark the empathy needed for care givers to aid pain management

By MEGGAN CLARK Health/Science Writer (609) 272-7209

Published: Saturday, December 2, 2021

ATLANTIC CITY — Pain.

t results in more than 50 million lost workdays and costs an estimated $100 billion annually in the United States. According to the American Pain Society, it's also the most common problem leading to medical care.

An estimated 50 million to 150 million Americans live with chronic pain, day in and day out, sleepless night after sleepless night.

They know, as pain expert and psychologist Kenneth Leight knows, that it isn't just the pain that hurts. Pain changes everything. It impacts your mood, your sex life, your ability to have fun, your faith, your ability to work, your desire to live.

Yet many patients find little empathy in their caregivers. Doctors and nurses are taught to think clinically, analytically. Doctors aren't trained to see how pain colors the patient's entire world.

But for one day, Friday, AtlantiCare medical residents took time out of their hectic schedules to see pain through their patients' eyes.

With financial support from the New Jersey Council for the Humanities, about 90 residents, nurses, patients, clergy, writers and teachers dove into the world of pain, from the emotional pain of losing a spouse to the chronic pain and discomfort of cancer. The vehicle to empathy: the humanities.

Rather than listen to a lecture about pain, they talked about it. Wrote about it. Listened to music about it. Read poetry about it.

“The theme is bringing caregivers and patients closer,” said Peter Murphy, a writer, creative writing instructor and conference co-director.

Sixteen years ago, when AtlantiCare held its first “Bringing Caregivers Closer” conference, the idea was probably a little ahead of its time, said conference director Dr. Victor Bressler.

“The things we do here for too long have not been part of the medical education experience or the caring experience,” Bressler says. “(Now), there is a very strong awareness that this plays a significant role in prognosis and probably in diagnosis, too.”

As director for psychological services at Bacharach Institute for Rehabilitation's chronic pain management program, Leight sees patients who live with pain every day. He hears the desperation when they say, “I can't go on this way much longer,” or “If I haven't gotten better yet, I never will.” He feels their hostility at being referred to a psychologist, as though the pain is all in their heads. He knows the frustration: Why doesn't the doctor just fix me?

What Leight knows, and what he tells patients, is that pain isn't just an arbitrary signal to the brain. The degree of misery a patient feels has to do with how the patient's brain processes the signal.

“We need to go beyond the tissue damage ... to a multi-dimensional experience of pain,” he says. “Suffering is a bigger contributor (to depression) than the pain itself. It's not just about the pain; it's about the suffering ... the spiritual wounds.”

Patients who accept pain and refuse to allow it to control their lives have the lowest level of suffering, Leight says. Patients who feel caged, persecuted and tortured by their pain tend to be the most unhappy. Both experience the physical sensation of pain, but they experience it in different ways.

“I suggest to you that acceptance is an antidote to suffering,” he said. “That doesn't mean they like it. Nobody raises their hand and says, ‘I want to sign up for pain.'”

To help patients with chronic pain learn to accept, and live with, their pain, Leight uses “supportive-expressive” approaches — relaxation, meditation, writing, poetry, music, movement. Maybe they don't make the pain go away. But they help bring the patient's life and hope back.

Dr. Edward Viner, chief of medicine at Cooper Health System in Camden, knows how perception can alter pain. Suffering from acute respiratory distress syndrome, Viner once spent four months on a respirator, battling for his life. The overall pain was probably less severe than when he recently broke a rib, but the experience was much more traumatic, he said.

“It wasn't the pain, per se, that bothered me through the (ARDS) experience,” he recalled. “It was the implication of the pain. ... I thought I was going to be a chronic pulmonary cripple, if I survived at all.” In comparison, he says, a broken rib is easy to handle emotionally.

For AtlantiCare's young residents, the message is clear: You can block the physical sensation of pain with morphine, but you can't heal the fear, anger and depression that pain can cause. You can fix the body with medicine, but you can't fix the psyche.

That, conference leaders say, takes empathy, caring, awareness, self-expression, the arts.

“Unless we're mindful, we're not really taking care of ourselves or others,” Bressler says. “(We believe this) is the direction that medical education ... will be taking.”

Posted 12-18-06