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Chronic pain—defined as pain that lasts more than three months—can be debilitating and all-consuming, affecting both physical and mental health. It shapes a person’s reality. And yet many, especially women, who describe their chronic pain as such find themselves being dismissed as overly dramatic.

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According to psychologist Jennifer Patterson, “pain is sexist,” with more women than men experiencing chronic pain. Moreover, women’s pain, especially when chronic, isn’t taken as seriously as that experienced by men.

Restricting our consideration of chronic pain to just its clinical aspects overshadows the impact it has on women’s daily lives. “[H]ow we think and talk about pain is influenced by general cultural beliefs,” Patterson writes. Both medical and cultural contexts “generate layers of meanings that intersect with those of individuals’ patient and personal identities (and roles) through the national, individual, local and familial cultures of which each person is formed.”

When chronic pain patients research solutions to manage their pain, they may be greeted with photos of happy “cured” patients, literal illustrations of what Patterson terms restitution, “the belief in bodies as mechanisms that can be fixed, repaired or cured.” Such images mythologize illness “as a temporary blip in the project of restoration to a previously healthy state,” denying the experience of chronic pain sufferers.

If a patient doesn’t live up to the progress of getting better, they may lose control of their own pain narrative. “When the body is in decline and cannot be repaired…the timeline proposed by the restitution narrative is no longer valid, where telling, listening and hearing become difficult or impossible.”

Chronic pain erodes individual agency, Patterson suggests. “There is a loss of time, of control and of making sense of life with financial knock-on effects and other difficulties.” Ultimately, chronic pain “disrupts an individual’s life narrative. A loss of agency in a pain situation is mirrored by taking on the role of a patient, a further loss of agency within the power dynamic of the clinic.”

The failure of the restitution narrative introduces the possibility that there must be something (mentally, behaviorally) wrong with someone who does not get better with medical care. Patterson argues that healthcare professionals should lean on—instead of dismissing—the way chronic pain patients describe their pain. Until recently,

the patient’s voice and language were subordinate in clinical settings. The clinician traditionally has particular frameworks for categorising pain, a range of other diagnostic possibilities…and represents answers and solutions to pain. This is a paternalistic form of care. Patient utterances take the form of narratives, verbal and non-verbal responses to questions, prompts, silences and reactions to clinical examination. Recorded as a case history, patient communication is changed, becoming interpreted text.

Rather than considering treatment an act of objective translation, with the medical professional interpreting the text provided by the patient, Patterson suggests that the treatment should be a partnership, with clinicians giving power to the patient suffering pain.

“‘Close listening’ educates the clinician or practitioner-listener to hear better,” notes Patterson. “Becoming a knowledgeable listener requires compassionate listening, practice, patience and observation.”

Other subjective forms of communication, such as story-telling, may also help patients verbalize their pain and its effects.

“One means of communicating a felt sensation is to translate it into something meaningful or recognisable to others, using a culturally shared or meaningful image,” she explains. “Through this process pain is sometimes personified so that it is given agency.”

Encouraging patients to sit with the nuances of the language used to share how they feel can be beneficial. “Language offers the potential for transforming chronic pain in individually different and complex ways,” Patterson concludes.

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Encountering Pain: Hearing, seeing, speaking, Chapter 20, pp. 315–335
UCL Press