Pain Behaviour and Empathy

Do you make judgements based on behaviours?

Pain behaviours are a communication tool between patient and clinician and other observers. They can help us to understand the intensity, pain pattern, and the patient’s threshold. It also allows us to identify what type of pain the patient has and what kind of patient has the pain… Simply, pain behaviour gives an excellent psychosocial understanding of the patient, their family, and their environment.

Pain behaviour can show us cultural values like stoicism, where some people avoid vocalizing mourn or groans. At the same time, others are very loud or vocal about their pain, like they need constant comfort. This could be very helpful in management where we can educate the patient and help them change their beliefs and practices. In patients with chronic pain, pain behaviours are frequently linked to the self-reported pain intensity scale. However, clinical assessment findings are not necessarily connected with this.

Pain behaviour doesn't correlate with self-rated pain intensity in the chronic population, and many things can mask this. It is hard to know that the patient has attention-seeking behaviour, is looking for a workman compensation plan, or just needs to learn good coping skills.

Either way, I try my best not to make judgements. As I do not want to miss anything about my patient, there could be many reasons for their exaggeration or stoicism, such as a psychological problem or PTSD. Even if I feel that the patient is exaggerating, it could be due to various valid reasons: the patient may have a low pain threshold, or they may think that if they don't vocalize their pain, nobody will take their struggle seriously. Before judging others, I like to put myself in my patient's shoes so that I can treat them better.

I saw a busy mom in my ER clinic. Her pain was out of proportion; upon taking a history from the family, I came to know it was the only time when she ever rested.

When confronted with a chronic pain patient, we should not make internal assumptions. We shouldn't participate in the dramatization, but we should, however, attempt to better grasp the situation and to be much more empathetic. I've come to learn that pain isn't always physical and that the patient’s level of suffering is frequently far higher than the clinical exam findings suggest.