By Vicki Rackner, M.D.

A parent, child, or partner in pain can bring even the strongest, most capable adult to his or her knees.

A patient of mine, Billy, said, “It was one thing to watch my kids have runny noses and not know how to get them to blow them so they'd be comfortable. It was something else entirely to stand next to my dad in bed and watch him struggle to turn over into a more comfortable position because it hurt to move. I bent over slid my arms underneath him and lifted him up as reverently and as gently as I could but his loud cry of pain was unnerving. It was very hard to see my dad in pain.”

How to Handle Pain

When should you offer a loved one pain medication?  Phone the doctor? Call 911? Choosing a course of action that best serves a loved one in pain can be a challenge. 

While there are no easy answers, understanding the way in which your loved one responds to pain…and how you respond to pain… offers valuable information that can guide your next steps.

Just as each of us has a style of dressing, so, too, each of us has a style of addressing pain signals. I noticed five patterns of “addressing styles” which I call the “pain personalities”: The Strong Stoic, The Worried Well, The Ostrich, The Victim, and The Ideal Patient.

I believe that each pain “style” is shaped in childhood and is largely unalterable. However, the way in which the pain style is understood and managed can literally make the difference between life and death. Communicating this pain “style” to your healthcare professional may be very important. It can help everyone in assessing how serious the pain may be. Additionally, if you have a conflict with your loved one about pain, it may be because you have different pain personalities.

The Strong Stoic

Gerda says, “You needed to be near death’s door before Mother called the doctor. Sure, money was tight. I think the real reason we didn’t go to the doctor was pride. Although Mother never said it, we knew that being healthy and being tough were sources of pride.  Illness and pain were shameful conditions that were hidden.”

If your parent is a Strong Stoic, expect that you will not hear about pain until the situation is quite serious. Be on the lookout for behaviors that suggest that something is out of balance – sleep changes, giving up a regular activity, or a voice on the phone that does not sound right. Emphasize the courage and the strength of character to seek medical advice and focus on the return to health. Make certain that all health care providers, particularly ER doctors, know if your loved one is a Strong Stoic. Say. “My mother rarely utters a complaint. When she says she’s in pain, I take it very seriously.”

The Worried Well

Another group, previously called hypochondriacs (and with new vistas of health information opening on the Internet, they may be called cyberchondriacs), we call the “Worried Well.” These are intelligent people who hear about a new illness on the news, recognize that they have several of the symptoms, and conclude that they have this illness! They know just enough to be dangerous. One out of four visits to primary care doctors deals with the latest concerns of the Worried Well. If the Strong Stoic comes to the doctor too late, the Worried Well comes too early.

The Worried Well group does best with regularly scheduled office visits. If your mother or father is a member of this club, you know how easy it is for you to find yourself tuning out during the long litany of new complaints. However, just as a broken watch is right twice a day, illness can really strike! So it is important to listen to your “Worried Well” loved one.

The Ostrich

We all need a healthy dose of denial to read the newspaper and get on with our days.  However, denial can go overboard and threaten health. The Ostrich hides his head in the sand during times of pain to construct a reality in which everything’s okay. Ann said, “After Thanksgiving dinner Dad was popping antacids for ‘heartburn’.  Mom was worried when she noticed that Dad’s grey skin was beaded with sweat.  Dad said that he was fine and he even got mad at Mom when she called 911.” But it turned out calling 911 was a wise thing to do, as Ann’s father was at risk for a heart attack.

If your loved one is an Ostrich, your most effective strategy is to understand your parent’s reality, then offer an alternative point of view that has the weight of a doctor’s authority behind it. “Yes, Dad, you may well just have heartburn. But your doctor insists that we make sure it’s not a heart attack.”

The Victim

Tom grew up in a family that unintentionally rewarded illness. He says, “Staying home from school when I was sick used to be more fun than family vacations! I had my mom’s undivided attention, and all the TV and ice cream I wanted.”  These childhood lessons about the goodies for being a victim of illness can carry through to adulthood. These people may associate love and affection with sickness. Being sick, therefore, is a seen as something more positive.

Kelly said, “Mom is always talking about her sleep problems. One day I came to her house to find her napping.  I heard loud snoring, then saw her hold her breath.  She looked just like the patient on the TV show about sleep apnea. Maybe Mom had sleep apnea and there was hope that she would overcome her sleep problems! I told Mom about my idea and said that I truly believed she should contact her doctor. But I know she never even spoke to her doctor about my idea. I’m not sure that Mom really wants to part with her sleep problem.”

If your parent is a victim, tough love is an effective approach.

Say to your parent, “When will you be talking with your doctor about this problem? Would you like me to join you for the appointment, so I can tell the doctor what I have seen?” The “Victim” may start to realize that his or her health problem garners more negative attention from you than positive—and this, in turn, may help them to address the problem.

The Ideal Patient

The Ideal Patient pays attention to his or her body, notes the whispering messages before a full-blown problem, and honors a well-developed trust in their intuition. The Ideal Patient knows when it’s time to make a doctor appointment. James said, “Mom had a new pain in her breast that worried her. She saw her doctor, who could not feel a lump. He said, ‘You probably just bumped it. Your next mammogram is in four months. Let’s hold off until then.’ Mom trusted her instincts and requested an immediate mammogram which showed a small pre-cancerous growth. She may have saved her own life by listening to her intuition even though her doctor recommended a different course.”

The Ideal Patient simply needs your support and encouragement to listen to the problem, even if the doctor says he or she does not see a problem. Say to your parent, “Yes, your doctor went to medical school but you’re the expert on your own body.”

When someone you love is in pain, it hurts.  Let your actions be guided, in part, by an understanding of the pain personality of both yourself and your loved one.