Irene Smith
Nov 7 · 3 min read

An Alternative Approach to Pain

Case History — Sabrina

While providing service in an inpatient hospice with an intern, we were asked to see a woman with cerebral palsy who was not on our list of referrals. Sabrina had spent most of her life in hospital wards. Her body was a roadmap of surgeries and called out loudly for tenderness.

Sabrina spoke of her legs and back being in great pain. She continued to speak of her discomfort as I positioned myself sitting comfortably at the foot of her bed. As I slowly lifted the sheet to assess her right leg my heart shed a tear for the dwarfed limb that was exposed.

I cupped my hand around the thigh and softly spoke. “I am honored to offer this limb some tenderness. I feel your leg loves the attention. I’m so glad we’re here.” While gently holding and tenderly petting this leg, Sabrina replied, “If someone had done that years ago I might still be at home.”

I covered the leg and Sabrina asked me to touch her back. She was in a lot of pain. She wanted a nurse to position her onto her side so I could touch the exact spot.

After positioning was completed I sat comfortably behind Sabrina on her bed, uncovered her back and with Sabrina’s permission, I came very close with one hand slipped under her head pillow to hold her. I simply laid my other hand on her back and said, “Oh, I know you have been in pain for a long time. I’m so glad we’re here.”

As I became comfortable and slowly exhaled, I felt Sabrina going to sleep. She said how good it felt before becoming silent. After a couple of minutes, I slowly re- moved my hand from underneath her pillow and changed places with my intern.

My intention is never to remove pain from someone’s body. Rather, my intention is to validate that pain exists and to create a space where the client’s anxiety about having pain can be eased. We are in a culture that insists that pain is something we have to get rid of. We essentially make pain wrong. Therefore, when pain appears, we are afraid of it getting worse. When we are experiencing it, we are always wanting it to go away. This directs a profound degree of energy to the pain and creates anxiety.

In hospice care there may be resistance and static around the bed of a client in pain. The caregivers may be in a state of anxiety and helplessness, as well as the client. No one is exhaling. Everything is stuck. The pain cycle is rigid.

When I walk into the room or up to the bed I want to create a resting place; a place of stillness first and then a place of very gentle movement like a breeze or a soft wave of water. A place where there is no resistance.

This is achieved through slow body movement, slow speech and slow audible breathing as I focus on my own comfort.

Just being comfortable and breathing as I slowly speak to my client.

This resting place, this alternative rhythm, eases a lot of tension in the room. There appears to be more empty space and the client might begin to find comfort in this space as well.

If I can stay grounded and comfortable in body and mind, then the circle of static and resistance has been broken. The cycle has to reestablish itself.

This change in the pain cycle around the bed can cause a decrease in the pressure being experienced by the client and give the client some breathing space.

Pain is a very intimate process. Pain may be my client’s most familiar response to his or her experience. I want to validate the relationship and offer as much tenderness to the process as possible. This may resonate as an alternative strategy for coping with pain in the future.

    Irene Smith

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