Patients need to be able to tell their whole predicament (life story). This is true because the source of chronic pain can be complex past trauma that is knowable only through telling. Allowing patients to explore the larger context of their pain bears witness to their suffering.

Narrative medicine helps the patient to draw the picture of his or her condition through words and emotions, including loss, trauma, the plot of the story, and many other aspects. It also helps to define the future and gives hope to the patient. According to University of Calgary sociologist Arthur Frank, “Health-care workers who bring a sense of narrative to bear have transformative effects.” Rita Charon, M.D., a physician and director of the narrative medicine program at Columbia University, advises the therapist to ask, “Tell me about your health, your body, and your life.”

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The following anecdotal story from Dr. Charon’s book Narrative Medicine: Honoring the Stories of Illness tells of these profound effects on one of her patients, a thirty-six-year-old man with back pain who had come to see her for the first time.

As his new internist, I tell him, “I have to learn as much as I can about your health—tell me about your health, your body, and your life.” I do not interrupt the man with pesky questions; I listen in an analytical way as if he were a character giving a soliloquy. I listen not only for content of his narrative but for form, its temporal course, its images, its associated subplots, its silences, where he chooses to begin in telling of himself, how he sequences symptoms with other life events. After a few minutes he stops talking and starts weeping. I ask why he is crying.

He says, “No one has ever let me do this before.” This “telling and listening” process improves the capacity of the clinician to recognize, absorb, interpret, and be moved by stories of illness. It also deepens the clinician’s attention to the patient. It is another healing tool that can be used to help patients with pain or any other condition.

How did this problem begin? What happened to create this pain?
How you feel now? What is the status of the painful part of the body?

Once this analysis has been performed and a logical explanation for the problem has been found, the patient can begin to accept the problem and its consequences. This facilitates healing and releases stressful emotions related to the pain. If some degree of denial occurs, however, and the problem is ignored or becomes buried within the subconscious mind, the patient may forget the cause and its effect. If the problem persists, doubts about the true nature of the problem may arise. This can generate questions based on fear and anxiety:

Why do I have this pain?
Am I becoming really ill?
Will I ever get better?
What is happening to me?

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By contrast, as long as a condition is not frightening and the patient understands and accepts it, the process of healing can occur unhampered by stress, anxiety, and fear. Even if a condition becomes persistent, if a patient accepts its existence, he or she can prepare to live amicably with the difficulties it presents.

An early diagnosis is, therefore, of utmost importance.

The earlier the diagnosis is made, the sooner the correct treatment can begin. If the patient receives reassurance from the doctor in the beginning that the condition is benign, or that the problem emanates from a local injury, from tension involving the muscles of the spine due to life’s stresses, and/or from poor posture, and that only minimal physiotherapy and increased exercise will be required to alleviate the problem, the patient will be more at ease.