Recalibrating our Understanding of Pain with Dr. Tara Nichols (Part 2)
Dr. Tara Nichols, DNP, RN
Dr. Nichols invites us to think beyond the 10 point pain scale when it comes to how we address pain. In this part of the conversation she invites us to think with her about the role of the environment in our experience of pain, comfort, communities— and what we are assessing and not assessing.
Introduction
0.00 Welcome to part 2, “Recalibrating our understanding of pain” of the interview with Dr. Tara Nichols, DNP and RN. For further details on her focus and expertise, please refer to part 1 of the interview, listed at the bottom of today’s post.
In this part of the interview we learn more about:
Perspectives on treatments options for pain— including our own views of pain— do we see it as something to be fixed or eliminated or an important messenger to tell us something needs our attention
The role of what we assess (and don’t assess) and how we treat it, including wondering about where we focus our resources (We hear that 80% of chronic pain issues do not have hospitalizations yet the bulk of resources for pain management are directed toward hospitals)
The impact of environment on experience of pain (including the therapeutic relationship)
Ideas for the future of pain and comfort, including ideas for those giving and receiving care, as well as how Dr. Nichols will be partnering with communities
01:31 And now— let’s hear the second half.
OT Recap
34:29 There is so much to consider in these conversations. We hope this is one of those conversations that inspires pause, curiosity, reflection and trying on some new things.
So as we recap this— what are some key moments to consider?
The difference language makes. We are asked to think about pain vs. comfort. Do we think of pain as a physical sensation only? Do we consider physiological, psychological, and emotional causes of comfort? How does this change if view pain as a valuable messenger to tell the body to pay attention?
And as Dr. Nichols reminds us—the opposite of pain is not the absence or not feeling pain— not being able to sense pain is another issue entirely. The opposite of pain is comfort, she reminds us— and, the goal in experiencing comfort is to be able to move through whatever is calling us to notice something may not be right.
How we define pain— or what we focus on, our perspective in our role of managing pain, the “why” of this sensation and the sources of that pain are among what she calls us to consider— whether we are experiencing pain or helping someone through it.
We are reminded that sometimes our approach to managing pain is what is fastest, not necessarily what brings us to comfort to move through what calls for our attention. We can see if we are trying to eliminate pain vs. focus on comfort our options for treatment may not impact what is actually causing that experience of pain.
“We don’t treat what we don’t’ assess.”—- Dr. Tara Nichols
If you are listening to this and are seeking help with pain management or someone you care about is working on managing pain— this conversation invites us to be curious about what this sensation is trying to tell us.
We are also invited to wonder about who are our partners in finding answers and solutions that we ourselves, are experts in knowing our own body. We are reminded to advocate for ourselves, notice the impact of our care team on our experience of pain (And how not being believed can exacerbate our experience of pain and discomfort). Remember when we talked about my experience with pain in childbirth— no medication was given throughout, but the therapeutic relationship was one of the biggest factors experiencing pain— what was known to be beneficial non-pharmaceutical interventions were not working— in fact, they were making it worse. Having the person who is there to help you manage pain and stay comfortable enough to birth something new— in this case, a child— is a key environmental factor in an experience of pain.
My body did not experience this person as safe. When we had a new nurse enter the room who listened to what I was saying worked or didn’t, who offered empathetic reassurance of what was happening in the birthing process— the experience moved from intense and nearly unbearable to a place of enough comfort to focus on the task at hand— birth this baby. As I reflect on this experience— Dr. Nichols words about self-advocacy, knowing who your team can be, health care teams recognizing they may be exacerbating pain (especially if they don’t believe you), and recognizing when pain is acute having the right partners to get you to a place of comfort to work through whatever the cause of pain is— is absolutely critical.
When it comes to Occupational Therapy in particular
Dr. Nichols asks all providers of care to ask patients/clients— “What is something taken from you that you want to get back?” This focus on function, occupations (anything you need and want to do), and what matters most are key to getting people back to lives well occupied.
Occupational therapists are experts in every day living and analyzing every day activities to find the “just right challenge” and next steps to work toward the function people are seeking. This conversation also called on us, no matter our role, to wonder who is on the team? What modalities may be helpful?
If the pain is caused by a physical, psychological, or emotional origin— is current or historical, or any combination of the above is part of what we are wondering about. How we create enough comfort to move through will be very different depending on what we assess or what we do not.
If occupational therapists are not part of a team for pain management and pain impacts people doing things they need or want to do— asking for a referral to OT and seeking OT consult on the team are both highly valuable options to consider.
Lastly— we have a glimpse at what the future of pain management could look like if we study more of the physiology of comfort and have comfort bundles by practitioners like Dr. Nichols. When we think about understanding what the physiology of comfort feels like— we can think of the role interoception (our ability to interpret our body’s internal signals— and what they are telling us) as key information into understanding what comfort feels like— and what facilitates or does not facilitate comfort as well.
We hope this is valuable to listeners in finding the right trusted partners to walk through listening to what the message of pain has to say to each of us is, and in being trusted partners.
As Dr. Nichols private practice begins to offer more possibilities— we’ll keep you posted. For now— find her on LinkedIn if you’d like to learn more or connect.
https://www.linkedin.com/in/tara-nichols-dnp-arnp-ccns-agcns-bc-pmgt-bc-87589658/
