Lessons from Hospice: Total Pain and Community Acupuncture

I recently spent a couple months caring for a family member at the end of their life. There’s much to process and integrate in such an experience. Not surprisingly, some of it had me thinking about community acupuncture. 

Dr Cicely Saunders, known as the founder of modern hospice care, referred to pain associated with the dying process as “total pain.” Total pain is the combined effects of physical, psychological, social and spiritual pain. There is a recognition, in the world of hospice care at least, that you cannot fully address a patient’s physical pain without addressing the other types of pain as well. 

In my reading I found accounts of patients with uncontrolled physical pain who, once their psychological or spiritual pain was tended to, had significantly less physical pain. For example: a patient in hospice with terrible pain, unresponsive to medication, revealed to a care provider their anguish about “abandoning” their children when they died. Hospice workers arranged for a family meeting and the patient was relieved to hear that not only were their children not upset with them, but they felt guilty for not being able to do more for their dying parent. It was a healing conversation all around, and after that, the patient’s physical pain significantly decreased.

I’m sure I’m not the first person to think or say that the concept of total pain does not only apply to dying people. It applies to everyone.

When someone comes in for treatment of physical pain, we always inquire about stress levels. I have probably said “Pain makes stress worse, and stress makes pain worse” a thousand times and the inverse is true. If we support someone’s ability to deal with stress their experience of physical pain is often lessened. 

Even though at Guelph Community Acupuncture we don’t have the means to eliminate many sources of pain in people’s lives — affordable acupuncture can’t get someone better working conditions, or end a pandemic, or arrange a family meeting — we can and do help people with different aspects of pain, thereby lessening their total pain.

We frequently hear from patients that acupuncture has treated a concern of theirs that they didn’t think to tell us they had. It happens so often that we joke about “treating something by accident”. We insert needles for low back pain and the patient sleeps better. We address a migraine with acupuncture and the patient’s digestion improves. We focus on treating depression and menstruation is no longer heavy and painful. For years I’ve explained this as “tipping over the first domino” within a system that has an innate lean towards health and repair. More recently I’ve referred to the wide-reaching effects of nervous system regulation to explain these effects. The concept of total pain offers yet another way to understand it. 

According to Cicely Saunders’ concept of total pain, you cannot properly treat a person’s physical pain without addressing their other kinds of pain. In our experience at GCA we have also found that you can provide relief for one kind of pain by treating another kind of pain.

Clients frequently come into GCA to work on physical and psychological/emotional pain, perhaps because we’re used to talking about these kinds of pain. We also see acupuncture ease social and spiritual pain, and the benefits of receiving treatment alongside other people has perhaps never been more obvious than during this pandemic when social isolation is affecting many of us so intensely. Loneliness is contributing to total pain for many of us, and can be tended to in community while treating other pain. 

If you have questions about how community acupuncture can help with any kind of pain, please get in touch.

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