Finding Hope in the Midst of Chronic Pain

Have you ever lost hope? Have you ever felt like there was no way out of your situation? Like no matter what you did, nothing would ever change? You’ve tried doctors, friends, the internet, and no matter what you try, there doesn’t seem to be a pathway out of what you’ve been feeling, what you’ve been dealing with for years. There are no answers, or at least none that make sense or that “feel” right? You get answers like “you’ll just have to deal with it,” or  “just do less,” or worse, “it’s all in your head, just get over it.” 

This is how so many patients who come to me for the first time feel. I walk in to the exam room, and I can see them sitting there dejected, in pain, with almost an empty look on their eyes. “Another doctor who’s going to tell me they don’t know what’s wrong with me”,

their face and mannerisms communicate. Sometimes they’re not even there of their own accord. A family member made them come, or their doctor told them to come and see me.  Yet another specialist, who, in their mind, probably won’t be able to help them anyway. 

“I just want to stop hurting”,

is often some variation of the first few words out of their mouth.

“I’ve been dealing with this for so long and no one knows what’s wrong.”

They’ve lost hope. They just want to get back to doing what they love, what they miss doing. But the pain is stopping them, and no one has seemed to figure out how to help them. 

This was a pattern I started noticing many years ago. Patients would show up for their new patient appointment in my clinic, already defeated. 

But, what if I told you that hope is possible, not just as a wish, but as a scientifically grounded pathway? Would you believe me? Let me explain. 

Hope theory consists of three main areas: Goals (the “what”), Agency (the “will”)  and Pathways (the “way”).  If someone is missing one or more of these three areas in regard to their situation, they often feel dejected or a sense of despair, the opposite of hope.  Patients with chronic pain, especially pain that has been difficult to “figure out” or treat, often come to me with very low levels of hope. The reason for this is that despite having a goal, what they want to get back to doing, or what their pain has been limiting them from doing, they have not found a pathway to do that. Some of them, because of months or even years of suffering, have even lost the will to keep trying to get better. 

Targeted Pain Treatment (TPT) combats this lack of hope in persons dealing with chronic pain by specifically addressing each of the components of Hope Theory. Principles 1 and 2, “Accurate diagnosis” and “Targeted Treatment” align with the Pathways component of Hope Theory.  Through careful and intentional history taking, including detailing the patient’s pain story, physical exam, review of studies, we first identify all of the causes of the patient’s pain and limited function. This process often reveals more than one underlying cause or diagnosis, many of which may be similar, yet distinct, and require different treatments. Once we have identified the pain causes, we then use the MIPS (medications, interventions, physical therapy, and psychosocial support) methodology to devise a comprehensive treatment plan. 

The MIPS  treatment plan is structured to support the patient’s achievements of their functional goals -  the things their pain is stopping them from doing.  The identification of these patient goals aligns principle 3 of TPT, “Focus on Function”  with the goal component of Hope Theory.   Throughout the evaluation and consultation process,  the patient’s Agency or will to proceed, is often bolstered through intentional patient “Education and Empowerment” (TPT principle 4), which ensures that the patient understands the pathway towards meeting their goals, and the role they play in their own success.  

By the end of the visit, the patient often exhibits a change in their expression and demeanor. Their eyes brighten, no longer empty. Their facial expression changes from one of dejection and resignation, to one of quiet composure, sometimes accompanied by a nod or even a smile. I have heard patients say, over and over again, “I finally have hope”.  The pain is still there, at the moment, but the what, the will and the way have now become clear to them again. They finally believe that they won’t have to suffer indefinitely with their pain. They have found hope.

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