People who have a chronic pain patient in their life often walk a fine line in terms of saying the wrong thing. Even the most caring person may inadvertently say things that can be hurtful. They may make assumptions or judgments in their language, not realizing they are doing so. In Say This, Not That, we identify some of these statements and offer alternatives.

Instead of: Does it really hurt that bad? Man up!

Suggesting that a chronic pain patient is less of a “man” or somehow less tough because they are in pain can be not only hurtful to the patient but also permanently damaging to your relationship with them.

Say: Time to call it a day? No problem. I’m ready, too.

Pain is the body’s way of protecting itself against further injury. In some cases, certain types of pain, such as the pain an athlete may feel in training, may be okay. When it comes to chronic pain, “manning up” can cause days or even weeks of backlash with intense pain and difficulty moving. Going at a chronic pain patient’s pace is telling them that it’s okay to feel what they are feeling and allows them the freedom to stop when they are done.

Instead of: There’s a lot you can’t do, isn’t there?

Talk about hurtful! Chronic pain patients are well aware that their condition has made life more challenging. There are activities that are no longer available to them, and they may never recover those abilities. To point this out is not only unsupportive but also downright cruel. There is no sense in highlighting what a chronic pain patient is missing out on.

Say: What do you enjoy doing?

Highlight the things that a chronic pain patient enjoys doing, and work towards those. If a patient says they loved to ride horses before their spinal injury, find a local horse rescue to visit. Do they love playing sports? Many types of adaptive sporting equipment are available for that. While they may never be able to compete in a hunter-pace or golf in a major tournament again, there are ways for chronic pain patients to enjoy the things they love. Accentuate what they can do instead of dwelling on what they can’t.

Instead of: Let me do that for you.

Chronic pain is often interpreted as helplessness. Even though awareness is growing, many still believe that chronic pain patients are unable to care for themselves in any capacity. Others may believe that physical exertion and activity are to be strenuously avoided and will rush in to take over every task, from little things like chopping onions to more physical actions like rearranging furniture.

Say: How can I help?

Before you take those groceries away from a chronic pain patient, ask first if you can help. Although chronic pain patients have days when even blinking is a painful activity, not every day is quite as challenging.

Treating a chronic pain patient as an invalid promotes a cycle of learned helplessness wherein the patient does little and then develops the ability to do even less. Physical activity and movement are actually recommended as much as possible for chronic pain patients, especially for those with conditions that worsen with inactivity (like rheumatoid arthritis). If you see a chronic pain patient struggling or about to fall from a burden they are carrying, don’t hesitate to assist. Otherwise, ask if they need help before swooping in.

Instead of: You are in pain? Here’s some aspirin/ibuprofen.

There are many different things that are wrong and potentially harmful in this statement.

  • Offering a chronic pain patient an aspirin for their pain is like bailing the ocean out with a teaspoon. Many chronic pain patients suffer from pain that an over-the-counter medication won’t even touch.
  • Assuming that chronic pain can be fixed by popping a pill – prescription or otherwise – is uninformed and plays into the stereotype of the addicted chronic pain patient.
  • Chronic pain patients who do take medication under the supervision of their doctors may have already taken their dose for the day, and to offer them more of anything can be dangerous.

Say: You are in pain? Is there any way I can help?

Chances are good that the answer to that question will be “no,” but asking to help instead of offering what you feel is the best solution is the fastest way to earn a chronic pain patient’s respect and trust. In doing so, you are not assuming anything about the chronic pain patient’s experience. You are making yourself available to help in any way that the patient needs, and that is an invaluable gift.

Instead of: Wow, you take a lot of pills!

Chronic pain patients who are taking prescription or over-the-counter medications for pain are already completely aware that they take “a lot” of pills. This statement may be embarrassing for them and may make them less likely to be open about their treatments with you.

If you are a caregiver, the last thing you want is a patient who feels like they have to hide their pills. This can make patients feel ashamed of their treatment and potentially less likely to follow it closely. There is also a strong emotional aspect of chronic pain, and treating a chronic pain patient like an overeager pill-popper is the fastest way to make them feel isolated and alone.

Say: I want to understand your treatment regimen. Are you willing to share?

Again, the answer to this might also be “no,” but asking the question instead of making assumptions is respectful and opens the door for better communication. In some cases, chronic pain patients may, indeed, be taking higher doses of over-the-counter medications than healthy people would take for muscle soreness or a headache. Encouraging the patient to communicate about their treatments, including medication and therapies, can build trust and let the patient know that you truly care about them getting better. If there is any question about medication amounts or you have concerns later on about prescription abuse, this foundation of nonjudgmental trust can make it easier to talk about your concerns.

Instead of: Have you tried______ (examples include: juicing, yoga, meditation, etc.)?

While some chronic pain patients have found relief from some of their symptoms through diet, low-impact exercise, and mindfulness meditation, others have tried everything they can find, to no avail. It can be very frustrating to have a pain-free person suggest treatments that may be scientifically unfounded and/or considered sham treatments or “snake oil.”

Say: What treatments have worked for you?

Chronic pain patients often have a long list of treatments they have tried, some of which may have worked better than others. Rather than assuming you can fix your friend’s pain with a well-intentioned but potentially uniformed suggestion, ask them what has worked or what they might try next. There is a fine line between wanting to be helpful by providing suggestions and being condescending and ignorant in assuming the patient hasn’t tried what they can. If you are a caregiver of a chronic pain patient, you will know where that line is. Others need to be more sensitive when offering suggestions and seek first to understand what has already been tried.

It is important to assume nothing and communicate with kindness and compassion. What are some other potentially hurtful questions or statements, and how can they be turned around?


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