Pain Management 3: Universal Precautions

I asked one of my patients, Serena, to help write a blog post about her experiences with chronic pain and acupuncture. Here's what she gave me:

pain… i feel like it has always been present in my life. i know there was a time when i lived free of pain, but i honestly can't remember what that felt like.

i have felt pretty trapped in my body, like i am on the outside of my life, unable to reach the door back in. i feel stuck in the pain and this has caused me to orchestrate my life around it. everything i do, i do with my limitations in mind. i do not take the bus, because i have no idea whether or not there will be too much walking for me to handle at my destination. i do not go to places where i might have to stand for a prolonged period of time or where there will not be adequate seating which means i do not get to go to concerts anymore, nor community events such as fairs or public speakers. i wait until my daughter is home from school to do my errands so she can go into the grocery store, take our dog to the dog park, etc., since these simple things are no longer things i can accomplish on my own. even visiting my friends is a challenge as they all have staircases or long corridors or winding pathways just to get to their front doors.

i used to embrace life. i climbed mountain trails to the top of waterfalls and danced all night under the full moon. i flew by the seat of my pants and never looked back. while in my early twenties, though, i was in a car accident that caused some permanent damage to my lower back. a year after the accident, the chiropractor who was treating me told me there was nothing more he could do to correct the problem and that i would have degenerative problems with this later on. at the time it seemed so abstract that i didn't give it another thought. i went on with my life, now with aches and soreness, but managed well for a while.

a number of years later, as i hit my early thirties, i was feeling the impact of the damage. i was still very active, but with every nightfall came a strong blossoming pain and fatigue across my lower back. i was traveling a lot during that time to festivals and fairs to sell my handmade goods, but started to rethink my choice of career as the gypsy lifestyle began to take its toll. i took a neighborhood job that would reduce my commute to a short walk down the street. i thought this would really help alleviate the back pain. unfortunately, with the diminished physical activity came new problems. pitting edema that had first cropped up when i was in college came back with a vengeance. sitting for most of the day was not at all good for my legs. my knees started to become very achy and i learned i had developed arthritis in them. i became pregnant and gained a significant amount of weight by the time my daughter was born. it was during this time that i realized my back was really in trouble. i was in near constant pain with it and walking became a struggle. i pushed through the pain, but with each step i took, in an effort to minimize my discomfort, i slipped further into the web of pain. i look back on these things now and can see a progression toward becoming less active but at the time i was only concerned with making the pain go away in the moment. i had become depressed and was feeling hopeless. stuck. miserable…

after my daughter was born i gained more weight.. a lot more weight. meaning that it's not necessarily clear how much of my mobility issues are now caused by my weight and how much are caused by the pain. and mobility isn't just about moving my body through space in the physical sense, it's about being in the world, dealing with other people.

i get nervous about going into situations that are unknown to me, places that are unfamiliar. i don't know if there will be a chair that will fit my body. i don't know if people will judge me because of my weight. it's hard enough to be in pain, i don't need the judgment too. when i have to walk in front of other people, i try to walk perfectly gracefully and not show that i'm in pain, because i know that people already think that i don't deserve to be here, out in public, out in the world. when you face that kind of judgment on a regular basis, you can feel it, whether anybody says anything or not. you feel it, and then you can't be yourself.

health care providers can be the worst.  in a health care setting, you never know if you're going to be treated like an adult, like a human being. i had an experience in a public health clinic that i'll never be able to forget. i could feel this lump in my abdomen and i was afraid it was something serious. the clinic was a teaching clinic so i ended up standing in front of a whole group of providers and students, and i was mostly naked. they told me the only problem was that i was fat. they told me to go home. they basically said that i can't possibly know what's going on with my own body, because i'm fat.  i was so traumatized that i didn't go to a doctor for three years, at which point the lump was diagnosed as a hernia, but what if it had been cancer?

so it was pretty daunting to go into an acupuncture clinic. i have been drawn to acupuncture for a long time but figured there was no way for me to get treatment since i do not have medical insurance nor the funds to pay the prices i had been quoted around town. then a friend of mine told me about WCA. i was desperate enough to try it, because i felt like i had so few options to deal with the pain.

so i walked into WCA, nervously, and i was immediately endeared to it because of how glad everyone seemed to have me here. i felt like every single person i dealt with on that first day, from Sandy at the front desk to John who was my acupuncturist, was genuinely interested in what they could do for me, and in me being in charge. people were kind. i felt like it was OK for me to be where i'm at, that maybe i even deserve to be where i'm at. one of the things that made me happiest was that i didn't have to take off my clothes. and then of course the recliners — when you have mobility issues, getting on or off of a table is really scary, not to mention feeling stable once you're up there. you can feel so vulnerable and exposed. but there just wasn't any of that at WCA. i felt like i could be myself, in the treatment, and that i could get the healing i needed and deserved.

when you're so used to dealing with judgment, encountering even one person who actually does accept you can really lift you up. when you're dealing with chronic pain, everything matters so much more because your world is so much smaller. everything good that happens is like a miracle.

so i started coming to acupuncture once a week but quickly realized i needed more regular treatments to really make a difference in my physical issues.the first thing i noticed was that i started to sleep better. the thoughts quieted and i could actually fall asleep. i've had insomnia since i was 3 years old. being able to sleep is such a huge thing, because when you can't sleep it affects every other part of your life. i was amazed at how much better i felt, just because of that.

coming to WCA over the last 6-8 months, i feel like i'm inching my way back into my life. feeling accepted at WCA made me feel a little bit braver about going out into the world. i'm seeing a blossoming in so many different areas of my life. i know that's how acupuncture works, it's so gradual, but it treats the whole person. my friends got together and bought me a membership to a health club, and i've started swimming a couple of days a week. being in the water is so wonderful because it allows me to have that range of motion. but i don't know if i could have done that before, because i don't know if i could have gotten past the inhibition of being in a bathing suit, being in public, trying to exercise. i had a kind of bad experience with a judgmental, condescending doctor at the health club — but because of coming to acupuncture, somehow i was able to not be affected by his attitude, i was able to think OK, whatever, i'll take what i want from what he has to offer and ignore the rest of it. that's the part i like the most about acupuncture — i know that it's treating my soul.

i deal with my pain easier now. and it has also really helped my focus and my mood. i find i am not dwelling on my limitations like i used to. i am stretching beyond my careful boundaries and a new motivation seems to be developing. i can feel my muscles strengthening as i'm swimming, and i can feel this other, internal strength, just growing and growing. hopefully, eventually, i'll re-enter my life with abandon. cleardot.gif

So there are some things that Serena brings up that community acupuncturists need to think about.

It seems like lots of people are getting over their distress about not being able to do all of the things that they learned in acupuncture school in a community acupuncture clinic, which is very good. I am hearing, in general, much less anguish about the lost potential of back shu points, akibani and shiatsu than I used to. So I don't want to resurrect that argument, I just want to point out that there are things you can do in a community clinic that you can't do in a one-on-one setting, ANY one on one setting, no matter how brilliant your treatment or how much you charge. Like allowing someone to be in a community.

A community has enormous healing potential for someone who has been isolated or marginalized –which, of course, pretty much describes everyone who is living with chronic pain, because as Serena describes so eloquently, that's what chronic pain does. But it's also what structural oppressions like racism and classism and all the other -isms do, they isolate and marginalize people. I know that there's a wide range of people who read this blog. Some of you are comfortable with concepts like privilege, and intersectionality, and fat acceptance. And some of you are, well, not so comfortable. For those who are comfortable, or at least willing to push their comfort zone, here are some well-written, thought-provoking links to blogs that address the connections between fat acceptance and: human rights, classism, disability, and feminism.

For those who are uneasy about the idea of fat acceptance, or “political correctness”, or the existence of blogs, period, I would like to propose a new set of universal precautions for practicing community acupuncture.

Every health care provider learns the concept of universal precautions. It's pretty simple and egalitarian: you can't tell what is going on with somebody's blood by looking at that person. So it's best to just assume that everybody's blood is teeming with every possible blood-borne pathogen, and to treat all blood with the same, appropriate level of caution.  It's pretty similar for oppression issues. You can't always tell by looking who might be on the wrong end of which oppression. But you can be pretty confident that everyone, at some point, has had interactions with society that make them feel worthless and powerless and hopeless. Your job is, as always, first to do no harm.

And yeah, there are a lot of different oppressions to learn about.  There are some issues, like Orientalism in particular and racism in general, that we need to be aware of and do some work around. Any of us white folks with a degree in “Oriental medicine” hanging on our wall  — we're obligated, seriously. We signed up for that one. And knowing what your patients are dealing with in their lives in terms of oppression is going to make you a much better practitioner, even if looking at our society from someone else's point of view — someone disabled, someone transgendered, someone old or young — can make you acutely uncomfortable. However, I do understand that all of the people reading this blog who are most likely to take me seriously when I write about this stuff are ALSO trying to start up and run their own businesses. Educating yourself about so many different oppressions may be daunting not because of the pain of facing your own privilege relative to said oppressions, but because your to-do list is already just too long. I get that.  So, universal precautions.

Start by assuming that every person who comes through your door is: 1) an equally valuable member of your clinic's healing community, no matter what they look like or sound like or think about anything in particular; and 2) in pain. Whether they show it or not, whether they even know it or not. In ways that you very well might not be able to understand, in ways that you might not be able to do anything about. And that's OK. Because the reason they came through your doors is that they are not just looking for something that you can do for them, but for something the community can do for them, just by being the community. 

The community being the community is the organic magic, the big love, the reason that so many CANners don't mind being paid working class wages for doing a “professional” job. The community connects people not only with each other but with themselves. You fall asleep with strangers and you wake up remembering who you really are. 

Chronic pain patients often frustrate professionals who pride themselves on their skills. But there's a whole other set of skills that you need in order to support a community being a community. Empathy is a skill. Being nonjudgmental is a skill. Allowing other people to be in charge of their own healing process is a skill. Even being happy to see people, all kinds of people, walk through the door is a skill. You can learn these things, you can practice, you can get better at them and rejoice in the results.

The truth is, it's not complicated or difficult to treat people who weigh 300, 400, or 500 pounds. They are not more trouble than anyone else, and they should never have to feel like they are. The same goes for people who are disabled, transgendered, old, young, non-English speakers, and people living with chronic pain. Acupuncture is simple, and diversity doesn't make it difficult. There is no reason on earth that any of those people shouldn't feel great about getting acupuncture and totally, unequivocally welcome in a community clinic.

Universal precautions don't just protect the patients, they protect us, the practitioners. They protect us from the craziness of making things harder than they need to be. They protect us from the pain of excluding people whom we might end up loving, who might end up loving us and acupuncture and also themselves in a whole new way if we just welcomed them in — if we, like Serena, pushed our boundaries to make our worlds a little larger.

P.S. If you are an acupuncturist in Oregon, next month WCA is offering a 6 hour workshop that fulfills the OMB Pain Management requirement, and it's taught by the fabulous Teresa Keane of the Oregon Pain Management commission (and also a little bit by me). Details here.

Author: lisafer

Related Articles

Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


Your email address will not be published. Required fields are marked *

  1. This could have been written

    This could have been written by a former patient of mine, except that it has a happier ending. When I moved from my BA practice in California to South Carolina, I looked for months for another acupuncturist to treat her. We tried several, but no one could see the sweet woman underneath the weight and pain, and nearly three years later she has more problems and more pain and more weight.

    This blog, more than any other post I’ve seen on CAN, convinces me that sole owner/practitioner of a CAP is doing only half the job. I’m going big as soon as possible so that when I retire/die/transmogrify someone will still be there to treat the patients in our community.

  2. thanks for these words

    please send our thanks to serena for sharing so much of her story with us. 

    these words will ring inside me a long time:

    health care providers can be the worst.  in a health care setting, you
    never know if you’re going to be treated like an adult, like a human

     everything matters so much more because your
    world is so much smaller. everything good that happens is like a

     that’s the part i like the most
    about acupuncture — i know that it’s treating my soul.

    i find i am not dwelling on my limitations like i used to. and i can feel this other, internal strength, just growing and growing.

     i feel like i’m inching my way
    back into my life.”

    thanks for these reminders about what is really going on in CA clinics


    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  3. Why I Love Cranky People

    I’d like to add crank-o-phobia to the list of -isms that a CA practice helps us, as practitioners, humble ourselves out of.

    I have this experience again and again. People arrive at the clinic for the first time and they are Cranky. Capital-C-Cranky. And they don’t make eye contact. They can’t. An hour or so later, as they finish tying their shoes, or they start folding their blanket, they catch my eye and smile.

    If you’ll indulge me while I make a slight dip into evolutionary biology, I just want to mention that our ability to smile at other people not only makes the smile-er and the smile-ee feel better, it also has great survival value. Smiles and eye contact are behaviors that bind individuals together into communities. And community – the opposite of isolation – is as critical to health and disease prevention today as it has always been to basic survival.

    Back to the clinic. I welcome the crankiest of crankies into the clinic. When someone has lost their ability to smile or make eye contact, it is a sign that *something has gone terribly wrong*. They are very sick, or in a lot of pain – or both, and a community clinic is a perfect environment for them to start feeling better.

    Crankiness is a sign of pain (you thought it was a sign of what, heat  maybe? 😉 Wink) When a capital C walks in, I am often overwhelmed with a sense of relief for them. They found their way to a welcoming community. They’re in the right place. A few needles, a few sleeping comrades, and they’re on their way back to the ability to connect, to survive, and to thrive.


    Michelle Faucher

    Chico Community Acupuncture


  4. Thank you Lisa and Serena.

    A wonderful and perfect reminder about keeping our hearts open to everyone who walks in the door.


  5. Lisa, you are such a gifted person

    and I am often humbled by your words.  I like the side of you that is gentle; it makes me see why your patients must love you so much.  You are an equal opportunity human.

    I can also see how your gentleness can win hearts and minds that may otherwise turn off, feeling the “crankiness” in your discourse.  I think the pain of clarity can make anyone feel cranky, but i like that you are finding the words that are more gentle on the ears, but profound in the soul.

    You and Serena see how it all works, thanks both of you for putting into words a structure by which we can all see how it works.


    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

  6. Now I remember

    There is nothing like acupuncture school to make someone want to be ANYTHING but an acupuncturist.  It is stories like the one in this blog and in the comments that make me remember why I am doing this.  Thanks to everyone here.  You guys make this long, irrational journey bearable.

  7. Thank you Serena –

    Thank you Serena for sharing so honestly about your experiences with us.  I’m glad to hear that acupuncture at WCA has been such a positive influence on your life.

    And thank you Lisa for brining up the -isms once again.  There are so many of them, and I have to say that I feel glad to have had CAN as a starting point to more learning and growth around these issues.  It also seems to me that any of us can use our own personal struggles, whatever they may be, as a way to identify with others who struggle, even if our own struggles aren’t the same.

  8. I love the two assumptions

    I love the two assumptions (every person has value and every person is in pain). To see so many patients here at CCA begin to take ownership of the place lets me know that they feel valued and are experiencing some kind of relief from or increased ability to cope with the burden they have carried. When I see patients begin to teach other patients how the system works here, help out without being asked by closing shades, emptying recyclables, or watering plants, or just give a smile as they head out the door after treatment, I feel like we are doing the job we set out to do. Patients challenge me to overcome my -isms about myself and the world around me and really, thank goodness.
    My job makes me a better member of my community. Because everywhere I go now I have the two assumptions – about the clerk at the grocery, about the shoe store guy, about my daughter’s teacher, about the pregnant woman crossing the street in front of me at a red light. Leaving the clinic at the end of the day, shutting out the lights and locking the door doesn’t make the awareness of value and pain go away. I am a better human than I used to be.
    I think some patients become better humans through community acupuncture as well. In a community room they see all sorts of conditions – today it was severe ticks and tremors of late-stage ALS, a broken foot, one post-surgical knee replacement complete with that electric pump thingie that pumps ice water around the joint, the weeping of chronic depression, the dark-circled eyes of methadone withdrawal. They wonder. They feel grateful for what they’ve got, what they know intimately in their own bodies. They feel sympathy, or empathy if they were there last month, or last year. They help each other fold blankets, get up out of chairs, find the acupuncturist on shift. Or just smile at each other.
    It’s “organic magic”. Today was one of those days I think to myself, man, I am just so lucky to have this job.

  9. P.s. I totally love what

    P.s. I totally love what Michelle from ChicoCA said about Crankies. They used to scare me too. Now I love watching the crankiness being loved and acupunctured right the heck out of them.
    Sorry to be so annoyingly upbeat about this topic – it was just a great, great day in CA land.

    Concord Community Acupuncture
    Concord, NH

  10. diversity awareness

    Thank you for writing this Lisa. I am ever humbled and delighted to be in your company. May I quote the first paragraph and link this article in my monthly blog? I think it would help a lot of people on both sides of the diversity divide – privileged and oppressed – to open their minds and hearts a little more.

  11. Required Reading

    This post is now the newest required reading for Team BAP.  Thanks again, Lisa, and so many thanks to Serena, for sharing.

    We are so lucky to have you here with us in this community.

    Julia in Berkeley

  12. A visual aid

    What if everyone who walked through our clinic doors had the source of their greatest pain written across their forehead? Or down their arm? Or across their chest?

    It would be whole lot easier to remember the universal precautions, I think.

    That is exactly what Tommy Corey is doing in the Self-Worth Project.

    I was introduced to this photo essay recently when Tommy came to Chico to photograph some of my friends.

    These are beautiful photos of people sharing, just as Serena did so eloquently, some of the greatest challenges to their own sense of value. Some of these are things we can see from the outside, like “scleroderma” or “fat”, and others are not so obvious, like “rape” and “inadequate”.


    Michelle Faucher

    Chico Community Acupuncture


  13. isms

    It’s time to stop focusing on all the “isms” around us – they simply become crutches. People who are affected unduly by the isms are suffering in their own issues. Others’ attitudes only affect us if we allow them to. Instead,

    We are creating a society where people are afraid to engage with each other because they no longer know (due to political correctness) what is okay to say, so they say nothing instead. All my black friends call themselves black but heaven forfend if we don’t say African-American in public. I live in an area with native Americans who all call themselves Indians but some well-meaning liberal will see me as racist should I lose the term.

    Our over-sensitivity and cultural guilt are killing open dialogue. Let’s just be people and get over the absurdity of PC language.