(This is ‘The McGill Pain Questionnaire’ Installation from Eugenie Lee. Try this – put some headphones on and turn up the volume as you read the post. What happens to your concentration and ability to recall what you’re reading? Is there a metaphor embedded in a metaphor here?)
A classic Catch 22
The basic idea behind Explain Pain is that learning about pain helps people to hurt less. But, pain can significantly impact our ability to learn – it’s a classic ‘Catch 22’.
It’s not just that pain can be distracting – it can, but some of the same processes associated with persistent pain, such as alterations in neuroimmune and neuroendocrine function, can also directly affect our ability to form new synaptic connections, lay down new memories, learn and think (some of the usual suspects, such as proinflammatory cytokines IL-1 and IL-6 play a role, but that’s for another time). Additionally, many medications, including antidepressants and long-term opioids can have detrimental effects on memory and learning.
More a question to ask yourself
Question 3 in The Explain Pain Assessment* is all about respectfully teasing out whether the learner has any impairments in their ability to learn. You may have picked something up in the first two questions, but it’s worth exploring further. ‘How’s the ole memory?’ might be appropriate in some situations, but something more formal will be needed in others. It might be one question, or it might be multiple questions throughout your assessment that build a picture. It’s more a question that you ask yourself ‘Does the learner have an impaired ability to learn?’
Understanding the biology of pain and being aware that you are highly likely to find some learning difficulties in people with persistent pain states (taking a range of medications) should be an essential part of your planning for providing an Explain Pain intervention.
What have you found out there in the clinic? Comments and thoughts are welcome below.