How to support a colleague who has chronic pain
As we all know, being in pain is a stressful experience. For those who have chronic and persistent pain which interferes with their ability to undertake normal tasks as it’s so debilitating and who must manage this as part of their ongoing experience, it’s even more so. As a colleague witnessing someone in pain, it can be very difficult knowing when to help, when not to, when to offer sympathy, when not to, when to suggest ‘it may be better if you stopped doing that and rest’ and when to let your colleague just get on with it. In this article our expert clinician Beverly Knops offers some suggestions based on many years’ experience of supporting people with persistent pain which includes vocational support.
It can be difficult to see someone we work with struggling to cope with tasks or obviously in pain. The natural tendency is often to offer help or support which is commendable. We do need to be aware of any assumptions we might be making and check these things out with our colleague through conversation though. It’s beneficial, for example, if the person in pain can be offered the opportunity to talk about their pain and how it impacts on their work in as relaxed way as they can so that they feel they can be honest.
As our specialist careers consultant often comments;
“When someone has a long-term health condition, it’s really crucial to be reminded that it isn’t that the person has lost their skills; it’s more a question of capacity and how these can be managed including having different expectations and making adaptations that lead to a realistic sustainable outcome’’
How can we talk about pain together?
The IASP (international association for the study of pain) defines pain as
“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
The definition is important because it links emotion and experience to the sensory event. This means that the only way of deciding whether someone has pain is by asking them or picking up clues from the way they behave.
How difficult it can be
“They just don’t understand….”
Over the last 25 years of supporting clients with pain conditions they have consistently said the same thing to me, regarding work.
They also quote various comments from colleagues, which whilst they are obviously trying to be supportive, can sometimes feel frustrating as the person with the pain doesn’t feel fully heard in their experience. These might be comments such as;
‘‘I know what you mean – my knee feels just like that”
‘‘There must be something the doctor can do”
“Have you tried a firmer mattress”
“You seemed fine yesterday”
“Should you really be doing that if you are in so much pain”
Part of what can add to this frustration is that it is very difficult to describe persistent pain effectively to anyone else. Everybody has some experience of pain but for most this is acute pain which is a useful warning sign that we need to take action to alleviate it. When you experience persistent pain there is rarely a simple solution. So, it may be better to avoid suggesting ideas like these to your colleague who has probably tried them already.
Trying to understand the actual sensory experience is difficult. Your colleague may use the terms burning, sharp, tingling, shooting, but do these words help you understand when you are not experiencing the same thing? They may tell you how they are feeling emotionally, but again this may be very difficult to understand.
Their appearance or behaviour may give some clues. For example, if they walk with a stick or crutches that will give you a sign that something is wrong. If you notice them rubbing their arm when it is sore that will give you some information. If their gait is awkward, or when they stand they put all their weight through their good leg, that adds to the picture. It’s easy to make assumptions about what these behaviours mean and it’s important to ask the question instead. For example, you might say;
“I notice that you seem to be struggling to [walk, hold the phone etc] and I am feeling concerned. I would be interested to hear more about what’s going on for you. I wondered if you would like to find a time to talk more about this with me and how I might be able to help?”
Or,
“I noticed that you seem to be in pain, which I am feeling sad about. I am wondering how I can support you best with this. Perhaps we could find a time to talk about this if you would like to?”
It’s worth considering that when at work people with pain often ‘put on a face’, try not to exhibit any pain behaviours or choose not to talk about it, or may need to talk about it in a different context rather than in the midst of a task.
This does not mean they are ok; they may spend their time outside work lying on the sofa trying to recover or be on a multitude of medications. Try not to assume that because a person looks fine, they are fine or that they have recovered from the pain.
What questions could you ask to increase your understanding?
One suggestion is to ask your colleague if there are any particular work or leisure activities that are difficult for them due to the pain and ask them how you may be able to help.
Here are some examples of the difficulties people might share with a bit of prompting:
“I have persistent low back pain which makes sitting or standing for any length of time difficult. This means that I must change my position regularly, so I hope you don’t mind if I stand up whilst we are talking.”
“I have pain in my hip which gets worse if I walk for longer than 10 minutes at a time. I would love to go out for lunch with you, but can we go somewhere close to the office.”
“I can still manage my full hours, but I need to take regular rest breaks, that’s why I disappear every couple of hours.”
“I find carrying these files to the other office particularly difficult. It would be really helpful if you could do this for me.”
“I would love to come to the pub with you, but I need to go somewhere with comfortable seats.”
“I won’t be drinking alcohol as it isn’t advisable with my medication and I need to be home by 10pm as I am trying to stick to a good sleep routine.’’
You may note there is very little information about pain in these examples. It is important to respect the fact that many people do not want to divulge details about their medical history. It can also be unhelpful to talk about pain regularly as this can focus attention on difficult symptoms when the person experiencing them is doing their best to divert attention away from the symptoms and focus on work.
Asking for some concrete information or specific instructions about how you can best help may reduce misunderstanding.
For example, you could say;
“I have noticed you are standing up at your desk more than usual today, is your back worse today? Is there anything specific I can do to help you?”
“Is there anything I need to consider when planning our Christmas party in relation to your pain condition?”
So, to summarise
Ask the question about the person’s experience rather than make assumptions
Ask what you can do to assist rather than offer suggestions before checking out what might be helpful to them
Remember pain can be invisible or fluctuate considerably and it’s about the person’s capacity to do things rather than their skills
Small changes such as postural shifts or more regular breaks can really assist someone if that’s what they feel empowered to do (i.e. without judgment from colleagues)
Support your colleague with acknowledging positives about their attributes or their ability/behaviour rather than colluding too much with the pain (which anxiety can often aggravate)
Keep things specific and related to behaviours/to what is observable, and keep your questions open (how, what, why etc) with a consideration of when it’s best to have these types of sensitive discussions
We hope these suggestions and tips are helpful for enhancing a supportive and respectful workplace environment for those with health conditions and their colleagues.
Written by Beverly Knops, Specialist Occupational Therapist, & Katherine Sewell