What is Pain?
Everyone knows what pain is, don’t they?
Not necessarily. We all think we know what pain is, until we experience it or try to describe it. Then things often get a little vague. We know we have it, but we can’t communicate much about it. All we know is that we don’t like it and don’t want it! Technically, pain has been defined as an unpleasant emotional and sensory experience associated with actual or potential tissue damage.
All pain can be divided into two general categories: acute and chronic. Acute pain is not called that because of its beauty, but is a term for the normal, protective response of the body to tissue injury or disease. It usually goes away after that condition has resolved. Acute pain responds in a “normal” fashion to various types of pain medicine and other treatments.
Chronic pain may range from mild to severe, and from intermittent to constant. While still making you miserable, it no longer serves any helpful purpose for the body. It can last weeks, months, years, or even a lifetime, and has recently been identified as a separate disease diagnosis, separate from the original cause of injury. Often it doesn’t respond as well as acute pain to the usual medications given to relieve it.
Chronic pain can affect many things in your life other than making your body hurt. It can also hurt your overall health and wellbeing. It can put you under financial stress, make you lose your job and house, take away your sense of who you are and what you do, and stop you from doing things you enjoy. It can prevent a restful sleep, make you angry, anxious and depressed, and develop a very negative self-image.
Chronic pain can ruin some people’s appetites, and in other people cause them to overeat for comfort and put on a great deal of weight, which itself may aggravate the pain. People in chronic pain may lose their ability to have comfortable sexual function, and often lose the urge to do so since pain control is a higher priority. It can damage marriages, reduce or eliminate social relationships with friends, and even produce severe social isolation.
It is imperative to manage your pain the best way possible to preserve and restore comfort, function, and quality of life. Despite the severe impact of chronic pain persons’ lives, it is often poorly managed or the patient is told he or she must “live with it”. It’s time to take your life back!
To get help for your pain, you have to ask and tell
To get treatment for pain, you have to ask your doctor for help, and give as many details as possible about the pain. If you have hypertension, your doctor can confirm it with blood pressure testing. If you’re a diabetic, your blood sugars can be monitored with lab tests. If you have pneumonia, usually your lungs sound different when your doctor listens to them, and an x-ray will confirm the diagnosis. Pain is different.
Your doctor can’t directly see or examine “pain”. He can see its effects, and come to conclusions about it, but not as well as we’d like. X-rays and MRI’s can show joint or tissue changes or herniated discs, but don’t measure pain. Therefore, the only way for your doctor to understand your pain and work on managing it is if, and how, you tell him about it.
Be as precise as possible. Use specific terms if you are aware of feeling a certain way. When you want to find your car in a shopping center or stadium parking lot, you can’t get much help if all you can tell security is “It’s a car, has 4 doors, not sure of the make or color; no idea where I left it; not sure how long ago I parked it”. Yet people in pain sometime limit their pain reports to the doctor to “I hurt pretty bad lots of places, fairly often. I don’t know if anything helps or makes it worse. I have no idea whether it’s sharp, dull, or burning. I don’t know how long it’s been there or whether it’s changed over time. I don’t want to guess how bad it gets – it changes back and forth.”
This kind of vague history leaves your doctor with no idea what your pain is coming from or the best way to treat it. If your pain is there only when you shop for groceries, treatment will be far different than if the pain is there all the time at a mild to moderate severity, worse and severe in the morning, flared and moderate when doing dishes or getting dressed, and limits you to only 5 minutes walking at a time. The type of medicine and dosing schedule your doctor selects depends on this type of information.
If you truly can’t remember much about when, how and why you hurt, keep a “pain diary” where you make notes several times a day about how bad your pain is, what is making it worse, your activity levels, and so on. This pain diary is a good idea for all pain patients at least on a once a day basis – you can summarize how you felt during the course of the day, and what activities you did that day. The more specifically you can describe the frequency, severity, and quality of your pain; what makes it worse or better, how it responds to various types of treatment, and how it affects your life, the more effectively your pain can be managed.
Helping your doctor help you
In addition to communicating clearly to your physician how your pain feels and how it affects your life, it’s important for you to know or help obtain the results of any previous testing, surgery, medication use, or injection therapy. Adequate records from other doctors can help a lot IF they were involved in diagnosing or treating your pain.
It’s helpful in the long term to ask for a copy of any diagnostic test, x-ray, or procedure report as you undergo evaluation and treatment, to keep in your own files about your pain. Try to keep track for yourself what medication was tried in the past; for how long; at what dose; and the results, good or bad. This can save you from having the same mistakes repeated if no records are available.
When you ask a doctor to manage any medical condition, including pain, it’s good to know what is being recommended for you and done for you and why. However, some people get so involved in that process they can’t be comfortable with the doctor’s decisions, and try to, in effect, become their own doctor. As with trying to take over flying a jumbo jet, most of us can do more harm than good with such attempts.
How to hire a Pain Physician
Although we often don’t think in these terms, you are hiring someone to work for you when you ask any doctor for help. Just as it’s important to hire the right person for a business, or hire the right dry cleaner to care for good clothing, you will want to know that your pain doctor will care for you in a way that makes you feel safe and trusting.
It’s a good idea to have some idea up front about your Pain Physician’s philosophy of care and any qualifications, including experience, to treat pain. While physicians generally can’t sit down for 30 minutes and let you interview them, you can tell a lot about them and their practice in other ways. Reviewing the physician practice website, talking to current patients, asking scheduling staff questions, and reading any brochures, and looking on the internet at sites such as www.healthgrades.com for records of censure or complaints are all good ways to get a feel for the physician and how he or she perceives and treats pain.
As a patient, you also will want to know whether or not he or she will prescribe opioids, work up new or undiagnosed pain causes, and be comfortable getting help with your management by referring certain problems out, if necessary.
As in the illustration above about trusting your pilot, so patients need in the long run to be able to trust their physician to know how to treat them; to be primarily interested in their well-being; and to listen to them. When flying, want to know that the pilot is licensed; the plane is well-maintained; the weather is watched for problems; and that the direction the plane is going is where we want to go. If the answer to that last question is “No”, then no matter how good the pilot and airline, we’re on the wrong plane! Similarly, in the realm of medicine there may be very good, skilled physicians whose philosophy of care or approach to patients doesn’t fulfill your particular needs. In that case, look for another physician!
