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Hurt by Johnny Cash

While I believe that the entire song Hurt is representative of physical pain, there are certain lyrics that stand out more than others. I believe that the song expresses how individuals with chronic health conditions or constant physical pain start to view him or herself and one’s life.

I focus on the pain, the only thing that’s real. The needle tears a hole, the old sting.”

For those with chronic or intense symptoms, pain becomes a part of who they are as individuals- whether this is how they view themselves or how they believe society views them. Physical pain can be immersive and all consuming. If the pain is constantly present, it may begin to take over one’s thoughts and lead the individual to obsess over it. Thus, the presence or absence of the pain can impact one’s view of reality since it has become his/her norm.

 Try to kill it all away but I remember everything. What have I become? My sweetest friend.” 

Pain can take a toll not only on one’s physical health, but additionally one’s emotional and mental health as well. While the pain may lessen or subside, those with chronic conditions are constantly aware of the impact the disorder has already had. Such impacts may include friendships, family relationships, education, and employment. Therefore, while the patient may be willing to do anything for symptoms to be relieved, he or she will still remember the influence that such pain has already had on one’s life.

Additionally, pain and chronic conditions have a huge impact on self-image. A change in self-image may be due to physical alterations, loss of confidence, hopelessness, or how much other members of society attempt to understand the pain. The reference to “what have I become” may also relate to how the individual has chosen to cope with the pain or any changes in one’s life due to such coping.

Full of broken thoughts I cannot repair. Beneath the stains of time, the feelings of despair.” 

If pain cannot be relieved or subsided, a person can be driven to feelings of hopelessness, anxiety, and depression. These emotions strongly impact one’s thoughts about the situation and the ability to continuously suffer through the pain. Therefore, I believe the lyric relates to how a person will progressively lose hope of recovery as more time passes without success.

While interpreting the song Hurt by Johnny Cash, I became aware that pain is a consuming experience that can impact a person’s self-image and self-confidence. For those with chronic conditions or long lasting pain, the feelings of pain can become one’s sense of reality; since the pain is constantly present, having pain allows the person to know that he/she is awake and alive. Furthermore, for many, pain is not a single experience that ends without having an impact on one’s life. Instead, people are reminded of how the pain impacted their lives physically, emotionally, socially, and mentally. Lastly, the song demonstrates the concept that if left untreated, such pain can lead to despair, desperation, and depression.

Questions: As healthcare professionals, what role do you believe PT plays in impacting how physical pain impacts a patient’s self-image? What are ways PT can help prevent feelings of despair in patients with continuous pain or chronic conditions (especially those that are uncurable)?


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  1. Hi Shannon! I really enjoyed reading your post! I think as healthcare professionals we play a huge role in patients perception of pain. I think one important aspect is simply acknowledging how the patient is feeling. If a patient is in chronic pain but other doctors are not taking it as seriously as they feel, this will definitely have an impact on their self image. I think patients with chronic or continuous conditions have a huge mental component that goes with their pain we as healthcare professionals need to also acknowledge. I think some ways we can help these patients is providing resources, referring to mental health specialist, or pairing them up with a mentor who is going through a similar situation for support.

  2. I think one of the distinguishing aspects of the PT profession (compared to others in the health care field), is that we will consistently see patients weekly for months (or more). Therefore, we have the opportunity to help those with continuous pain or chronic conditions in a unique way. Depending on the condition, different patients will need different treatments. Functional mobility can look many ways. For example, a cancer patient might not have the strength to go through their therapeutic exercises, but if you can get them outside and encourage them as you walk 100 feet, you could significantly improve their physical and mental pain by leaps and bounds. By consistently being a source of encouragement, while being create and flexible, we as PT’s have the opportunity to meet a patient where they are and be a bright spot despite despair and chronic pain.

  3. An important thing to keep in mind as a PT is how we frame someone’s condition. The language we use about their injury or illness can be very impactful on their view of themselves. For example, if we say, “you have a full-thickness lesion” or “complete tear” they are more likely to internalize that they have a very serious issue that will be hard to overcome. This can contribute to their pain in unforeseen ways, and exacerbate their symptoms if they only have a very medical view of their condition. On the other hand, if we say, “you have an injury to these muscles, this is how we can help your pain go away,” they will know there is hope for recovery. The same thing has been mentioned in class about whether or not we advise someone to get imaging; often it will not change anything about how we treat them, but will only make them more anxious.
    With conditions that are progressive or incurable, this idea definitely becomes harder to apply. But being careful of our language and always make sure we reflect back how the patient is feeling is very important. We can help them have a better outlook, but we don’t want to add anxiety with unfamiliar or serious-sounding language.

  4. Shannon,
    This speaks to my experience as a patient when I had my ACL surgery and why I came to PT as a profession. I felt like my self-image was at an all time low when I lost my mobility and independence as a 22 year old. I can’t imagine what it’d be like to deal with this loss life-long. But patients do, they must. My PTs are who helped me believe in myself again and give myself hope that one day I’d be able to get back to my normal life and do the activities I love again. They were my best cheerleaders, believing in myself when I didn’t. Even though we’re PHYSICAL therapists, we often serve as MENTAL ones as well.

  5. I think PT plays an important role in a patient’s self-image when dealing with physical pain because as you mentioned in your post a lot of times this pain can become a part of the patient’s identity and they slowly lose hope of ever getting better. However, with PT there is some pain management skills that they can learn through different movements and exercises and it can give patients a sense of control over their pain and take back control of some aspects of their life. To prevent despair in patients with chronic conditions, I think it is important to be a listener but also a motivating person in their life. It is important to validate their feelings, but also be someone who reminds patients of what they can do despite the chronic pain they are feeling and not crush their hopes.

  6. Shannon –
    This is an excellent contribution. I love the fact that you chose a song and your presentation and interpretations of the lyrics is well done both in the content that you offer and the actual visual display of the information. You and your colleagues have made a number of really important points in your discussion.

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