From Health Literacy…
After two questions last week, a moment to pause on this single, key question: Question 6 in The Eight Great Questions from The Explain Pain Assessment*.
Health literacy is the ability to seek, understand and utilise health information, and is important for good health. By extension pain literacy is the degree to which a person is able to obtain and process pain related health information. In Australia where there has been large population studies, we are aware that around 60% of Australians have less than optimal health literacy. There’s no population data specific to pain literacy but many people hold fundamental misconceptions about pain, for example that pain is a direct measure of tissue injury, with pain receptors sending pain signals to the pain centre in the brain (and it’s not just patients who hold these misconceptions…).
…To Pain Literacy
It’s not easy to determine an individual’s pain literacy – there’s no single measure for it (although the Revised Neurophysiology of Pain Questionnaire may be part of a larger assessment). But there are a few questions to add that will help you form a sense of where a patient might be coming from. No surprises – the key is to listen, really listen, to the responses:
Tell me what you understand about the problem?
What’s your theory about what is making you hurt?
What do you know about your diagnosis?
How do you think I can help?
Most patients have answers to these questions, although it can take some careful and respectful questioning to elicit them as some people will be worried about being made to look silly (perhaps based on past experience within the health system).
But caveat questioner – here’s a common response that we’ve found: I don’t know what’s causing it – you’re supposed to be the expert. You’ve probably heard this from time to time? We might respond, respectfully, with something like:
Thanks! I am also very interested in what you think is going on because this is a really helpful indicator of how your brain will be processing all kinds of information from, and about, your body.
That last response is also a gentle way to start introducing some Explain Pain content – do you see what we did there!
What’s your experience of patients’ health literacy? How have you dealt with difficult responses to questions when you’ve tried to elicit a patient’s understanding of pain? Comments welcome below.
Knowledge driving health
* The Eight Great Questions in The Explain Pain Assessment come from Explain Pain Supercharged, available at noigroup.com (worldwide) or at the NOI US distributor, NOI UK shop, NOI Nederland shop.
Thank you for bringing attention to the importance of literacy in health education! I am an occupational therapist in Edmonton, Alberta, Canada – part of my role in our rehabilitation clinic is to conduct an ‘Explain Pain’ seminar for clients experiencing chronic pain. In the province of Alberta, 44% of adults have “inadequate literacy skills” – which suggests that almost half of the clients attending our clinic will fall into that category. Creating pain education material that accommodates low literacy levels is challenging! Concepts from the ‘Explain Pain’ book have been tremendously helpful with this.
Thanks Kathryn. Yes, it get’s even tougher when basic literacy issues compound health and pain literacy difficulties. Sounds like you are doing great work to help people overcome both.
In my experience, patients explain “perfectly” their interpretation that pain is a warning of damage / injury and that pain avoidance leads to greater limitation. The critical point arises, in my opinion, when our questions “wobble their truth”: is my pain really a sign of real danger? Is the painful movement really more harmful than its avoidance? … After these questions, that perhaps for the first time arise in the patient, reveals the presence of resistances to change. Resistances to modify/adapt the thoughts … emotions … and behaviors. And they are gradually deciding what it is for them to believe one or the other.
Thanks for dropping by and sharing your thoughts and experience. I like the metaphor “wobble their truth”!
Thanks for this topic. I like the links you’re making to wider health topics (eg where do people go to learn about their health, and health literacy). The more I learn about the brain, the more I am drawn into “other” fields of health. Parallels can easily be drawn between the brain in pain, the brain in depression, the brain in addiction etc. For patients that do have an interest in health in some way or another, some of these topics can be a “back door” into talking about the brain in pain.
For those who aren’t very literate in health related topics, we can still use simple concepts that are fairly widely understood to draw parallels with the brain in pain. For example, most people can relate to the idea that loosing weight requires behavioural change and takes time – it’s not pleasant, it’s not easy, and many days it is tempting just to give up and “start again on Monday”. Losing weight is not just about what you eat and how much you exercise, it requires a change of thinking and a challenge to existing ways of dealing with food and movement. It can be a “hard sell” to wiggle across from concepts like weight loss to using movement and education to treat pain, but there ARE similarities once you get the brain on board.
I continue to find the “sell” quite a challenge, despite my passion for pain education, and am very interested in reading the responses from others.
Whilst the task of improving the health literacy of consumers has received considerable attention, the sharing of meaning demands that medical terminology be logical, consistent and unambiguous. This is important because different interpretations of the same terminology can be an important factor in determining health-related behaviours and outcomes of therapy.
There is another side of the same coin. Those who are undertaking pain education have not as yet addressed the problem of having to use medical terminologies for which there is no consensus on meaning among experts, even when they are communicating with their colleagues. If such language is not logical, consistent and unambiguous, it is quite understandable that consumers will tend to be confused.
Just posted something on feeding hippos that might be relevant here on a number of levels. https://noijam.com/2018/02/09/at-least-we-fed-the-hippos/
Brilliant talk. I can see your point.
just came across this.
Now I Walk
Carol Snyder Halberstadt1
Author Affiliations Article Information
JAMA. 2018;319(6):619. doi:10.1001/jama.2017.7666
Only in my mind
and in dreams sometimes
when free again I climb
up and down the rocks to mesa rims
or wander miles on familiar earthen paths
to sit by streams and ponds
with calling frogs
and watch the darting dragonflies
and red-winged blackbirds
singing in the reeds,
or lie down upon a hummock
of the meadow grass,
to rest within the trees.
Only my mind is not the same
as once it was.
Thanks Ralph, a beautiful verse.