Narrative Medicine in the Context of Childhood Chronic Pain
Previous studies have established that medical testing cannot detect all types of physical pain. Individuals that are victim to a system where a physical and usually quantitative measurement of pain symptoms is customary, often are left feeling helpless and resigned. This issues sets up the importance of narrative medicine in a clinical setting. Using a qualitative measure to supplement medical testing is helpful is arriving at a holistically derived diagnosis to better treat the root of the ailment (Hurwitz et al., 2004). Principles of narrative medicine allow the patient to tell a complete story with a beginning, plot, and end, in which they are given the liberty to shape their retelling of their symptoms around a larger narrative of their life (Sandelowski, 1991). Narrative medicine in the realm of chronic pain and children is especially appropriate to discuss. Patients experiencing chronic pain are often dismissed and invalidated by physicians because they are unable to find an underlying cause. Narratives by children are often viewed as incredible sources of information for diagnosis because of the their age. A 2009 semi-interview style study was conducted with children ages ten to eighteen regarding their chronic pain. The goal of the study was to understand the role of chronic pain in the context of the rest of their lives via a qualitative analysis. The narratives that the children shared had several overlapping themes, allowing researchers to create certain archetypes. The study suggests that the archetype of the story told by the patient should be taken into consideration and that the physician should aim to eventually remodel the narrative after treatment to put the patient in a powerful role in the narrative of their life.
Figure 1. One of the leading graduate level programs dedicated entirely to narrative medicine
One fallback of the use of narrative medicine include that it takes more time to be able to tell and listen to a patient’s narrative. Additionally, narratives are subjective. Even though it is a form of raw data from the patient regarding their pain, subjectivities are inevitable in patient-physician relationships due to the structural confines of class, race, and gender (Lorde, 2003). Not only this, but if the patient has told their pain narrative to another individual before visiting their physician, how that individual responded to the narrative– perhaps a facial expression, gesture, or comment– may incite the patient to retell their narrative differently to the physician. (Meldrum et al., 2009)
Citations:
Columbia University Medical Center | Program in Narrative Medicine. (n.d.). Retrieved December 03, 2016, from http://www.narrativemedicine.org/
Hurwitz, B., Greenhalgh, T., & Skultans, V. (Eds.). (2004). Narrative research in health and illness (pp. 1-20). Malden, MA: BMJ books.
Lorde, A. (2003). The master’s tools will never dismantle the master’s house. Feminist postcolonial theory: A reader, 25, 27.
Meldrum, M. L., Tsao, J. C. I., & Zeltzer, L. K. (2009). “I can’t be what I want to be”: Children’s Narratives of Chronic Pain Experiences and Treatment Outcomes. Pain Medicine, 10(6), 1018-1034.
Sandelowski, M. (1991). Telling stories: Narrative approaches in qualitative research. Image: the journal of nursing scholarship, 23(3), 161-166.
