Discourse - Relieving Pain: What's in a Name?

Abstract

Several years ago I had a conversation with Leora Kuttner, child clinical psychologist and author of the seminal works The Child in Pain (Kuttner, 1996) and No fears, No Tears: Children Coping with Cancer (Kuttner, 1986). This conversation changed my thinking and the way I speak about what it is that we do as clinicians to help people in pain. During our conversation, Dr. Kuttner challenged my use of the term "non-pharmacological" when referring to cognitive and behavioural interventions to relieve pain. She said the term indicated a bias towards pharmacological interventions and implied that cognitive and behavioural interventions were inferior. Since that conversation, I have tried to be meticulous in my choice of words when describing interventions to relieve pain in infants and children. Although the language becomes cumbersome at times, I have tried to avoid the term "non-pharmacological" when I really mean behavioural and environmental interventions. I try to avoid implying that pharmacological interventions are the gold standard for pain relief and that we must choose one kind of intervention over the other. I have argued that environmental and behavioural strategies provide the foundational substrate for neonatal pain management to which pharmacological therapy is additive or synergistic (Franck & Lawhon, 1998).