Communication Strategies for Describing the Mind-Body Connection to Patients in Conversations About Their Pain

The Center for Health Communication Think Tank, an initiative of Dell Med and Moody College of Communication's joint Center for Health Communication, provides free 1-hour health communication consulting with an interdisciplinary collective of experts to equip health care providers with practical communication strategies and tools they can implement into their daily work immediately.

A recent client-champion who approached the Think Tank for communication strategies was Dr. Mark Queralt, a physician at the UT Health Austin Musculoskeletal Institute who cares for patients with spinal pain and injuries. Mark shared that often when patients come to him with chronic pain, they frequently want an explanation to their symptoms and seem reluctant to accept treatment recommendations that involve mental health, such as meditation or therapy, without an understanding of where their pain is coming from. Patients showing no injuries on an MRI sometimes reject Mark’s suggestion that the pain they are experiencing can be related to anxiety and depression. Mark described a scenario to illustrate these difficult conversations:

I have a long-time patient with manageable non-specific back pain treated with non-narcotic pain medication. By coincidence, I knew him as a coach of a local sports team, and I knew that he had lost his job when he came in to see us the following day with an acute flare of back pain. The patient said he bent over and his back went out, but he didn’t connect his severe flare with his loss of job, despite pain occurring within hours of his notice.

In trying to explain the mind-body connection, my strategy from a pain standpoint is to normalize the reactions of our nervous systems and explain how some people’s systems tend to be more sensitive than others. I liken it to Diabetes – many people are able to control their sugars by diet alone; however, if they were to add a piece of chocolate cake to that diet, their sugars would get out of whack. Stress, then, is the “chocolate cake” of this sensitive nervous system. It has physiological effects, like a drug. If you have an awareness of that, you can control it on your own (through meditation or stress management), which can also act like a drug.

Stigma as a Barrier

Mark’s first question to us was – “Is the utilization of a physiologically based cognitive construct as explained helpful to engage a patient in mind-body exploration?” To which the Think Tank responded it depends; Some patients can be skeptical or uncomfortable discussing it because of stigma. Dr. Heather Voohees elaborated on Mark’s observation above that the link between mental health stigma and resistance to pain treatment is very real; it is rooted in the idea of weakness. Hearing that their back pain may be linked to depression or anxiety, a patient might hear “You’re weak in BOTH mind AND body,” feel dismissed and become defensive.

Timing Matters

Another challenge in this context is that pain flare-ups can make it difficult for patients to fully engage in a discussion about a mind-body intervention. Remington shared that from a psychological perspective when people try to suppress the thought of pain, it takes an increasing amount of effort to not think about it, which in turn leads to cognitive overload. Anna Osborne explained that introducing a mind-body intervention may not be appropriate for patients during a flare, because a patient is cognitively depleted from chronic pain and may not be able to utilize the information until they have at least partial relief and restoration.

Opening the Conversation  

In many responses, Think Tank members underlined that there is no one-size-fits-all approach to opening the conversation about the mind-body connection and pain, but that it must be handled delicately. Laying a foundation of support is necessary for such conversations to occur successfully. These conversations require communication that is validating, tailored to the patient, and shows compassion. If you’re interested in learning about all of the strategies recommended by the Think Tank, read the full summary. If you are interested in scheduling a free 1-hour consulting session with the Think Tank, send the team an email.