How to talk to your doctor about chronic pain

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How to talk to your doctor about chronic pain

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Good chronic pain treatment can be hard to find. A chronic pain

patient has every right to believe that his or her doctor will listen

sympathetically and prescribe the appropriate treatment, but that is

not always the reality.

People who experience chronic pain should be specific when describing

it to their doctors, experts say.

Truth is, many doctors have not been trained to deal with the

complex, changing area of chronic pain treatment. One 2001 survey of

primary care physicians' attitudes toward prescribing certain

medications found that only 15 percent said they enjoyed working with

patients who have chronic pain.

This can lead to frustrating encounters at the primary-care level,

especially if your doctor is rushed.

Pressures on doctors

" Doctors don't want patients to suffer; they want people to get

better, " said Dr. Bill McCarberg, founder of the Chronic Pain

Management Program at Kaiser Permanente in San Diego,

California. " But they feel stress; they feel time constraints; they

have to deal with pre-authorizations; it's not the kind of practice

they wanted. They're stressed, and that leads to moving patients

along. "

" As a doctor in today's medical system, it's difficult to deal with

chronic pain conditions, " agreed Dr. S. Sam Lim, a rheumatologist at

Emory University School of Medicine in Atlanta, Georgia. " Most

practices are forced to see a certain number of patients in a limited

amount of time. [With chronic pain,] it's not so simple as five

minutes, a few questions and handing out a pill. It takes some time.

And our system isn't set up for that. "

" The patient needs to realize that the doctor may not be able to

discern what's going on in the first visit. Often, it takes a few

visits, " Lim said.

In 25 years of caring for her chronically sick husband, who was

injured in an industrial accident, Ann s, 62, of Laramie,

Wyoming, has watched physicians struggle with the trial-and-error

progress of his treatment. " Doctors are programmed for success

stories, " she said.

Because of its complexity, pain treatment has emerged as a separate,

multidisciplinary specialty. That's good, but pain patients often

need to get to a pain specialist through their primary care

physicians.

Emotions can cloud the diagnosis

The emotional effects of chronic pain may make diagnosis more

difficult. Maggie Buckley, 46, of Walnut Creek, California, learned

this the hard way. She has Ehlers-Danlos syndrome, a rare genetic

tissue disorder that leaves her with chronically painful joints.

" If you say, 'it's really depressing and upsetting me; I'm in so much

pain,' " Buckley said, " doctors will see it in terms of emotion and

treat it as an emotional problem, referring you to psychiatric care

or antidepressants. "

That is sometimes the appropriate treatment route, because

antidepressants can treat chronic pain, and there is a link between

pain and depression, but you need to stand your ground and make sure

any treatment is addressing your specific problems.

Be gentle about your pain, but be firm

It's important to be clear about your pain and explain the way it

impacts your life when you're talking to your doctor. Don't be

intimidated. Stand your ground, calmly.

" Patients really need to be persistent about their complaints in a

way that is constructive to get across to the physician that this is

something real, " Lim said. " There are some physicians who are more

open to listening than others. It may take a few doctors to find a

marriage. "

" You have to go very gently to start with, " s advised. " Listen

to what the doctor has to say first. "

Then, if you're not satisfied, press harder. But remember that the

most important thing is to create a relationship with your doctor in

which you're a team, both looking for the best way to alleviate your

pain. After he or she has assessed your needs, you can consider

seeing a pain specialist.