In some ways it is trust that makes the human world go round. In order to get out of bed in the morning I need to trust that the man who built my house did a good enough job that his work will last for more than 50 years. To get a bus or an Uber into town I need to trust the engineers who made the vehicle, and I definitely need to put my trust into the driver. When I get a coffee I need to trust that no one at the cafe will spit in it because they are jealous of my disarmingly handsome facial features and impeccable dress sense. That’s a lot of trust and it isn’t even 7:30am.
There are many treatments for chronic pain. At the more medical end of the spectrum there are various surgical interventions that can be useful for a thankfully small number of cases. There are also thankfully many pharmaceutical options that can make life better when we are in a pinch. At the pain science/rehabilitation end of spectrum there is rehab exercise, acupuncture, manipulation, ultrasound, ice, TENS, acupressure, mobilisation and a host of other options that can be explored.
The funny but annoying thing about stubborn pain is that we each have a highly individual requirement for achieving relief. Two people of the same age and gender with the same complaint that they have had for the same duration can be found to need surprisingly different treatment approaches. This means that when you are looking for relief you sometimes need to be very patient with the people and processes involved in finding relief. If you have exercises to do they probably won’t just work overnight, if someone like me is treating you they will probably end a bit of time to figure out what combination of treatments will work for your pain.
Once you are in a pain treatment program it is trust O’clock. In many ways it’s like a high stakes version of what I do when something goes wrong with my car. When I hand my keys over to car mechanics all I have is trust, they could tell me it needed a $3000 haircut and I’d just have to take their word for it, such is my knowledge of mechanics and engineering.
The uncomfortable truth is that when we agree to treatment with any healthcare professional on any level we are entrusting them with something we don’t understand well ourselves.
Levels Of Trust
Would you trust me to lock you in a box in my basement for an hour? Don’t worry it’s quite comfortable and it has air holes! Not really my thing and I am sure it’s not yours either… but think how much trust that would take if I had the key to that box and I just left you in there. That sort of activity would take trust on a grand scale.
Now reflect on how much trust is involved in getting surgery under general anaesthetic, it’s really not that different: Being under a general anaesthetic we are arguably even more powerless than if we were buried alive. We trust completely that the surgeon, the anaesthetists and all the support staff will do the best thing by us. Not only do we trust that they have sufficient skill to keep us alive, we trust that they won’t draw a Mexican moustache on us and rub hot chilli sauce on our nether regions we are under.
The trust we show when we agree to a general anaesthetic is truly massive. But without it where would we be? Dead quite possibly, and maybe that’s why we are willing to offer up that level of trust, the absence of remotely appealing alternatives.
It is interesting to reflect the role that trust plays in surgery. It is literally the only thing we as a patient need to do, be passive and trusting enough to let it all happen. And yet without that one essential offering the whole process ceases to be possible. If you run and hide your surgeon isn’t going to send the Men in Black to come and retrieve you. Without showing up to, trusting and submitting to your life saving surgery you are toast.
Trust In Chronic Pain Management
Now, the level of trust I require from my patients is actually far far less than your surgeon requires from you. And yet there are many of you who still struggle to ‘hand it over’. This is completely understandable especially given that many of the concepts I have to offer chronic pain sufferers are brand new and possibly even quite alien to them. Additionionally it often it takes extended periods of time and expenditure to resolve the more stubborn forms of pain that show up needing to be rehabilitated in any clinical practice. The more time that goes by without clear improvement the greater the trust required to continue, thankfully most find some improvement very early on in treatment which makes it a whole lot easier.
Time is an essential ingedient for any form of physical adaptation, one trip to the gym doesn’t do much in and of itself afterall. Time and trust often influence eachother profoundly within the healthcare and rehabilitation sphere. The longer you know your practitioner for the more you are inclined to trust them, but only if they are able to clearly demonstrate their integrity to you. Time can just as easily erode trust in a patient-doctor style relationship if there isn’t clear and consistent communication, accountability, rapport and honesty going both ways .
The simple fact about trust in pain management (and just about every other form of healthcare ) is that without it there really is no healthcare. There are many possible ingredients that can be added to a healthcare equation both interpersonal, educational and clinical but without trust they all amount to nothing.
I honestly believe that I am only able to offer meaningful help perhaps 65% of the people who walk through my clinics front door. Of those that are able to trust everything that I tell them and ask them to do however, I believe that number probably jumps to more like 95%. The more you are able to trust me and the longer you are able to sustain that trust for the more likely it is that I can help you. This is because for a percentage of us pain relief is a gradual problem solving process. If this is true (which it is or thereabouts) what does it say about that value of trust once you are with the right practitioner?
Whether you are treating headaches, neck pain, shoulder pain, back pain, hip pain, knee pain, ankle pain or foot pain it’s probably going to take time. If you are new to pain rehab that’s probably one key understanding that will get you through the early stages of treatment, the part that comes before improvements where trust is at a premium.
Trust is only a virtue in healthcare if it is placed in the right spot.. obviously. This is the struggle for patients often, who should I trust. That is something that no one can really advise you on, in the end it’s your decision. What I would add though is that your should strictly only work with people who you trust. Even if your intuition is poor you are still truly best to follow your gut and see where it leads you then learn from your mistakes as you go.