The “Five E’s” of Chronic Pain

A few weeks ago, I sent the roundtable a short article I put together called “Ability and Motivation.”  These are the two key ingredients necessary to create true change. My point was that the current state of the worker’s comp system destroys both of these attributes.  The only logical choice in light of the complexity of any worker’s comp system is to arm the worker with these tools.

There was a discussion last year that led to a document called “The Five E’s of Chronic Pain.”   They are:

  • Empathy
  • Evaluation
  • Education
  • Encouragement
  • Engagement

All of these are geared towards enabling and motivating the patient to take charge of his or own care.

One E that I want to emphasize in particular is education   it’s critical for several reasons.  If a given patient is willing to immerse him or herself in learning about all of the variables that affect his or her pain, the chances of them eventually improving is extremely high.

Conversely, if they are not willing to read, listen, and learn, then they cannot and will not get better.  They must be willing to take on that responsibility.  Otherwise they are choosing to remain in a victim role and will remain angry.  It is also difficult to work with them, which also makes progress unlikely.  I think it is important for those working in chronic pain to set personal boundaries while still “keeping the door open.”  If you are attached to getting that resistant patient better in spite of their wishes, you might get yourself into a very unhappy, energy-draining situation.  You need to let them go.

I just put on a mini-seminar called “Enjoying the Management of Your Chronic Pain Patients.”  Once a given patient decides to fully engage, it is like opening the door of a caged wild animal.  You cannot stop them from regaining their life.  It does not matter how long they have been in pain. Working with these patients has become the most rewarding and enjoyable part of my practice.

NH, BF