Is Compassion the Ghost of Pain Management?

by Ann Quinlan-Colwell, PhD, RNC, AHNBC, DAAPM

Twenty years ago, when she read my holistic tee shirt with the numbers “2 + 2 = 5” the young store clerk smiled and confided “I wasn’t good at math either.”  That tee shirt exemplified the holistic concept: the whole is greater than the sum of the parts. That holistic concept is particularly true when working with people with pain management.  Historically, the interactions between health care providers and patients involved a therapeutic component that enhanced the beneficial effect of the medications and treatments which were provided (Decety & Fotopoulou, 2015).  Today, when they sense empathy and compassion from clinicians, patients continue to report greater satisfaction, less anxiety, and feeling safer, with improved outcomes demonstrated (Dempsey, 2018; Quinlan-Colwell, 2009; Vogus & McClelland, 2016). 

The term and concept of compassion are discussed frequently in health care.  Although no definition for the word compassion is provided in the 10th Edition of the Mosby Medical Dictionary, in that resource, compassion is listed as a component of “ego strength”,  “emotional support”, “nursing assessment”, being “sympathetic”, and “waking imagined analgesia” (envisioning and focusing on an enjoyable past experience).  Nursing theorist Delores Krieger teaches that compassion is not only essential for working with someone using the energetic modality of Therapeutic Touch®, but that without compassion Therapeutic Touch® is not possible. 

Although compassion clearly is important in health care, it is often poorly understood or even misunderstood.  To effectively discuss compassion, it is essential to understand what it is and what it is not. As with pain, compassion is multifaceted with various components and supported by a number of theoretical positions (Goetz, Keltner, & Simon-Thomas, 2010). The Merriam Webster Dictionary defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it” (N.A., 2018).  Merriam Webster also defines sympathy as  “feelings of pity and sorrow for someone else’s misfortune,” and defines empathy as “the ability to understand and share the feelings of another.”  With all due respect to Merriam Webster, considering those definitions, I suggest that compassion is not “sympathetic consciousness of other’s distress,” but rather it is conscious awareness of another’s distress together with concern for the other and a desire to alleviate the distress.  This definition is essentially consistent with Goetz and colleagues definition of “compassion as the feeling that arises in witnessing another’s suffering and motivates a subsequent desire to help“ (2010, p. 352). 

Thus, with compassion there is not only a conscious awareness of the distress of another, but there is also caring about the pain and suffering of another combined with communication of that concern, with an impetus to ease the suffering and improve the status of the other.  It is that desire and stimulus to help the other which especially distinguishes compassion from empathy (Chierchia & Singer, 2017).  Thus, it is manifesting the emotion or experience of compassion into a therapeutic response/action which distinguishes compassion as a particularly unique trait or emotion different from other emotions.

Even though it can be associated with and related to love, anguish or sadness, from an evolutionary perspective, compassion is a particular emotion or state unlike love, anguish or sadness (Goetz, Keltner, & Simon-Thomas, 2010; Kagan, 2014).  It is an innate aptitude which has been refined in the brains of mammals to facilitate a particular connection with others for the purpose of survival (Decety & Fotopoulou, 2015; Goetz, Keltner, & Simon-Thomas, 2010; Kagan, 2014; Wright & Pendry, 2016).  Compassion is not a quality unique to humans, which is well known by humans who live with animals.   It is most likely the very rare person who lives with animal pets who has not experienced his or her pet acting with compassion when the owner was ill, injured, grieving or emotionally distressed.  Compassion is the source and reason why the healthy and informed members of a group or society care for those who are vulnerable.  Compassion then is first experienced with the care received as infants, and that compassion conveys senses of trust and mutuality which support meaningful relationships (Goetz, Keltner, & Simon-Thomas, 2010).  In health care compassion not only facilitates, but is essential for healing, and was described by Delores Krieger as being the quality “that powers the engine of a healing relationship” (Hanley, Coppa, & Shields, 2017, p. 375).

Today, that aged holistic tee shirt is a reminder that good health care and effective pain management are more than just writing a prescription or administering a pill or administering a therapy, or providing education.  Compassion is a basic premise of health care and the reason for working with people living with pain, it is how 2 + 2 becomes 5.  Too often patients living with pain feel undertreated, frustrated, labelled, and judged, while health care providers feel frustrated and burned out, and  while health care system leaders feel they need to acquiesce to electronic medical record documentation, time constraints, government regulations and accreditation agencies. As a result, too often the whole seems even less than the sum of the parts (2 + 2 = 3) with medications and treatments not working as well as expected.

Although the majority of  patients and health care providers believe compassion is a critical component of health care, many believe it is often missing in U.S. health care today which led to the identification of a current compassion crisis (Trzeciak, Roberts, & Mazzarelli, 2017). It is curious to ponder whether it is just an interesting coincidence that this compassion crisis is co-occurring at the same time as the opioid crisis or if rather there is a correlation between the two crises. Today, compassion often seems to be the ghost of pain management begging to be re-actualized to enhance pain management and make the whole analgesic effect greater than the sum of the parts. 

This is the first of a series of explorations of compassion in pan management. The next segment will be a discussion of compassion fatigue followed by developing self compassion and finally the importance of restoring compassion in the work of pain management.


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