Keynote Address w/ Melanie Thernstrom

When Melanie Thernstrom went swimming in a pond 14 years ago, she had little idea the event would trigger a sensation of pain in her right shoulder so severe that it “felt like demons were breathing fire onto it." Thernstrom, a journalist and author of The Pain Chronicles, became a chronic pain patient from that day forward.

As the PAINWeek 2010 keynote address speaker, Thernstrom shared her story as well as those of the patients she followed and wrote about for her book, which is listed on The New York Times extended best-seller list. In the book, Thernstrom chronicles the stories of pain patients and their physicians, all interviewed by Thernstrom in an attempt to go behind the scenes of pain management from the sufferers’ and clinicians’ perspectives.

Thernstrom’s pain is caused by spinal stenosis and occipital neuralgia. According to Thernstrom, it took a long time to get treatment for the condition, mostly because she had a high tolerance for pain. As soon as she did receive the diagnosis, she remembers experiencing a sinking feeling as the doctor explained it was a chronic condition.

Part of the difficulty in accepting the diagnosis is understanding what it is to be a chronic pain patient, she said. Before becoming a patient herself, Thernstrom said her model of treatment usually centered around acute pain or illness. A patient sees a doctor, is examined, receives medication, and gets better. With chronic illness, there is no easy cure.

The end goal is to manage or see some improvement, not a cure. Thernstrom found the same was true for patients she interviewed. It took her many years to accept that she would not be cured, she said, but once she did, she was able to work with her physician to get her pain to tolerable levels. It was through working on an assignment from The New York Times, following chronic pain patients, that she truly began to gain insight into the pain experience, she said.

Among the findings she highlighted was that chronic pain “dramatically reduces the gray matter of the brain.” In fact, "living one year with chronic pain is equal to living two healthy years," she said. By going with patients to their appointments, she was able to interview them after their interaction with the doctors and see what their thoughts really were about the process. Thernstrom found that they were not persuaded by the doctors’ arguments or suggestions, she said.

Many of the doctors she observed didn’t see persuasion as being a part of their duties. But this is a part of a bigger picture, Thernstrom explained. It's something that practitioners shouldn’t ignore. Similarly, Thernstrom said she was amazed by how low the level of compliance was with these patients, and of all the recommendations made by the doctors, she found patients failed to truly give physical therapy a try. Yet when they visited alternative medicine practitioners, she explained, they were willing to make many changes. What she found was the more the patients believed that their doctor truly wanted them to get well, they usually complied more and did show improvement.

Thernstrom concluded by saying physicians need to improve their persuasion skills and make sure to deliver the good news and the bad news to the patients—preferably the bad news first.