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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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Improved Communication Strategies can Aid
Headache Treatment |
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BY MAURY M. BREECHER
Contributing Writer |
BOSTON — The patient, not the clinician, is the
authority on pain but clinicians need to realize the
pain the patient is experiencing can present a barrier
to patient-doctor communication, said Dr. Kathleen
Farmer at the 50th Annual Scientific Meeting of the
American Headache Society on June 29.
However, there are specific strategies tailored that can
overcome that barrier, noted Dr. Farmer of the Headache
Care Center of Springfield, Mo., and communication
between doctor and patient occurs the moment the
physician walks into the examining room.
“Consider this scenario,” she suggested. “It’s been a
busy day and you walk into the room and look seriously
at the patient. Right away, the patient responds
internally, ‘Oh no, he’s thinks that is something
seriously wrong with me.’”
Meanwhile, you see this woman who has perfect hair,
perfect makeup, yet she is telling you that she has
these awful headaches and can’t tolerate them.
“You are thinking this doesn’t mesh [with what I am
observing],” said Dr. Farmer.
“Right there is a barrier to communication with the
patient,” Dr. Farmer continued. “Effective communication
dissolves that barrier between patient and clinician,”
said Dr. Farmer.
Dr. Farmer explained that pain is a sensory and an
emotional experience. “Headache pain rapidly registers
on the cortex of the brain, but that’s just half of the
message. At the same time other pain impulses travel
over the slower C nerve fibers and register in the
limbic lobe, the central part of the brain.”
Taking the role of the patient Dr. Farmer acted out what
she feels is the patient’s conscious or perhaps
subconscious thought: “Since I have just had pain, that
tells me the world is a dangerous place. I have to be on
the lookout for when the next pain is going to occur. I
have to brace myself for the next pain.”
“Now if the pain is burning one’s finger on a stove,
just taking the finger off will reduce the pain and that
tells my body, ‘I can let down my guard now’, but
headache pain is different. It comes out of nowhere like
a bolt of lightening within your head and doesn’t stop
right away.”
The result: The body doesn’t get a message that it is OK
to relax.
“So, there is a somatic sensory part and then there is a
limbic part. Some patients have no idea of the limbic
connection to their pain experience. Other patients do
know but they are afraid to tell you because they are
thinking, ‘It sounds like I am a nut case. I can’t
think. I am irritable. I can’t see anything positive.
The doctor will think I am seriously impaired
psychologically and he will write my headaches off.”
“Effective communication dissolves the barrier to
communication and empowers the patient, enhancing the
efficacy of medication,” said Dr. Farmer.
How does that work?
“When you really listen to the patient’s story, the
patient responds by thinking, ‘My doctor really cares
about me. He is listening so I’m going to do exactly
what he tells me to do,” explained Dr. Farmer.
“Effective communication increases patient compliance by
creating a trusting relationship between clinicians and
patients, and it gives the patient responsibility for
monitoring physical well-being under the physician’s
supervision,” she concluded. |
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