A small group pain management program can offer an opportunity for people with chronic pain to open up and tell their health stories. These stories are often filled with unconscious experiences of grief, anxiety, and depression. High rates of anxiety and depressive disorders in chronic pain are worrying.1
These feelings, if not released, can act as a waste weir or dam of negative emotions that bind, intensifying physical pain. In addition, ongoing stressors such as strained relationships, stressed finances, and work related legalities jam the dam.
All aspects of chronic pain patients' lives are under pressure. Patients frequently hear, "We cannot find any cause for your pain." leaving the patient without a satisfying diagnosis or explanation for the pain.2 Relief seems doubtful. Purposeful living can disappear.
Story theory offers the conceptual framework for the storytelling and positive change that takes place in the participants of this nurse coordinated educational pain management program. In addition to understanding pain, there is also a need to talk about the pain to someone who will actually listen. Listening is vital. Listening can be healing.3
The purpose of this experimental, longitudinal, prospective study to evaluate if engaging patients with chronic pain through storytelling, enhanced by art and journaling, in an educational pain management support program changed patients' perception of chronic pain intensity and depression. Art was used to make the stories visual. Journaling orders thoughts and provides a written historical account to the stories.
- Facility: Interventional Pain Management (IPM), part of a regional healthcare system serving a suburban/semi-rural population in Central Pennsylvania, was the location of the study.
- Participants: A total of 96 patients participated in the program. The majority of participants were Caucasian females. Twenty-two males attended. The mean age was 57 years. Forty-two participants had spinal surgeries. The participants suffered from a variety of medical diagnoses related to chronic pain syndrome as well as psychological diagnoses.
- Program: One of the multidisciplinary modalities offered at IPM was the nurse coordinated pain management program. Small groups of <8 patients with chronic pain met for 2.5 hours once a week for 10 weeks every spring and fall. The first hour provided a licensed guest lecturer on the following topics related to chronic pain: acute versus chronic pain, proper body mechanics, breathing, spiritual values of grief, relaxation, goal setting, diet, medications, art, music, guided imagery, yoga, and acupuncture. The second hour and half consisted of an activity and open dialog led by the nurse. For example, participants sculpted self-images from clay during one open discussion period (see Fig. 1).
- Data: Data were collected from 18 groups. The Numeric Pain Intensity Scale and The Geriatric Depression Scale were completed for quantitative data on the first and last days of the program. Questions qualifying journaling and art were completed on the last day.
- Results: The results of this study support using storytelling, art, and journaling in a pain management program to manage pain and depression related to chronic pain. Fifty-eight percent had a decrease of pain, and 60% had a decrease of their depression. Greater than 50% of participants perceived that journaling and art decreased pain.
Engaging patients with chronic pain in a small group educational program opens the waste weir mentally and emotionally. Medications and procedures intervene physically.
One gentleman in the program, a watchmaker, exemplified the impact of telling his health story and expressing himself through art. A collage, made the story visual. A small audience listened intently as the watchmaker stood to reveal segments of his life since his motor vehicle accident.
Pointing to his collage (see image below) ingeniously made from watch parts and magazine print he unknowingly revealed Smith and Liehr's3 story theory concepts of intentional dialogue, connecting with self-in-relation, and creating ease as well as concept dimensions, reflective awareness, flow, and anchoring.3
The physically weakened watchmaker was recovering from recent neck surgery. His head fell slightly forward, cautious about using his weakened neck muscles to address individuals in the group.
With a frail voice, the watchmaker opened up and his story unfolded.
"After my auto accident, I had to have neck surgery. I still have pain when I do close work," said the disappointed watchmaker as he dwelled on the self-photo, "that's me in a patient gown."
Intentional dialogue was initiated.3 The watchmaker pointed to a photo of a lady and an antique car.
Seated facing the watchmaker, the attentive nurse encouraged the concept dimension of querying emergence, urging the storyteller, "Tell me more about the photos."
"My friend and I used to enjoy driving up to the other end of the state where this antique car is stored. I can't travel like I used to," the watchmaker lamented.
Reflecting back to a different segment of his life, the watchmaker spoke freely about his trade, "When I set a spring, I must focus on my breathing, hold my breath, and relax. Relaxing eases my pain."
Connecting with self-in-relation to his health challenge, he voiced a concern. "I wonder if I'll ever go back to work?" he said, then paused, thoughtfully contemplating, "I can
only work for short periods and then I have to rest."3
Allowing these waters of sorrow to pour out, he also told stories about the impact of his interests on his pain.
"I enjoy listening to talk radio even though it gets controversial. When the controversy gets too serious, I get tense and notice my pain increases. That's when I change the station and I feel better."
He had spontaneously exercised Smith & Liehr's concept dimension of reflective awareness.3 The watchmaker was aware of his ability to change a negative impact to a positive action, managing the health challenge, chronic pain. The dam of negative emotions was breaking, creating an opening for the waters of sorrow to escape and cascade to more positive emotions.
The other participants in the group marveled at the intricacy of his story symbolized by watch parts.
To the watchmaker, the mechanisms represented his passion.
Through reflective awareness, the watchmaker was able to make an analogy,
"The watch mechanisms are a lot like the complexity of pain," he said. "Just as there are different types of pain, the mechanisms are different sizes and made of different colored metals," he said.3
Looking at the collage again, the watchmaker continued, "Making this collage made me realize that I am creative and have a lot of experience." Again he connected himself in relation to his health challenge.3 "In spite of my pain, I can still be useful."
He was anchored.3 He was anchored in the moment of understanding and acceptance of his own story. The watchmaker's story had meaning and he embraced it. The waters of sorrow were calming. At peace with his discovery, the watchmaker experienced flow.3
Story segments came together. The watchmaker opened the floodgates of his heart, creating ease.3 The bold print along the side of the collage dynamically reflects the watchmaker's prevailing emotions, It is time to let go! The watchmaker had embraced his story. He moved toward a life with purpose teaching watch repair.
References for this article can be accessed here.
Carol A. Jones is a pain management nurse, Wellspan Interventional Pain Management, and Rod D. Grim is senior research specialist, Emig Research Center, York Hospital, both in York, PA.