Pain Management, Communicating with your MD & Public Perception

Chronic illnesses can cause chronic pain, and pain management is shrouded with problems.  Thus, the true pain patient has an unnecessary struggle for treatment.  Sad but true–it’s getting worse–and the pain medication tide is turning sour because the level of abuse is beyond comprehension.  Sadly, it’s true.

As patients, it is our job to be responsible, prepared, educated and cooperative–even when it sucks to do so.  Patients have to  educate themselves and jump through the necessary hoops–NOT to prove they aren’t addicts but to show the physician A. The patient is doing his/her part toward maintaining health & not looking for a cure in a pill -AND/OR  B.  He/she is sincere in the quest for pain management.  The problem with this is PATIENTS & DR’s SPEAK DIFFERENT LANGUAGES!! 

I am a chronic pain patient working in the areas of acute care, mental health and substance abuse–so I see the communication process fail every day, from all sides.  My goal is to close the gap a little and improve outcomes for pain management.  The more prepared a patient becomes, the easier it becomes for the MD to properly treat him or her & weed out the frauds.  Many times the doctor has a reason for the things they do and the patient simply doesn’t understand.  I’m not condoning bad treatment; my goal is to help patients understand there is a process in place that even good doctors have to somewhat adhere to, especially in treating new pain patients.  PLUS, it is critical to be open and honest.  We’ve gotta tell the bad with the good!

First, understand that there are different types of pain & they each respond better to different types of medications.  Learn about the different types of pain such as somatic, visceral, nociceptive and others.  Check out this EMedicine site for more information.

Next, learn to describe your pain effectively.  When, where, for how long, is it constant or intermittent,  what were you doing when it started, does anything help it or make it worse, what does it feel like-stabbing, sharp, aching, cramping??  Be objective and thorough; keep in mind-pain is a symptom and ALL physicians are required to find the source of the pain & try to fix it.  The Pain Resource Center has some great information. It is irresponsible to hand over a narcotic prescription without exploring for the source.  Period. Even if the exploration process hurts.

Also, keep track of what you take and when.  Keep an updated medication list in your purse or wallet ALL of the time. Keep track of when & why you take your pain medication. Document whether it helped or not and when you started having pain again.  It’s simple to do, just carry a pocket calendar or little notebook.    It is  our responsibility to do our part and keep track of our progress.  This is especially critical in determining a maintenance doses and in the titration process.  If the patient is unable to track it for cognitive reasons, a trust-worthy person has to step up and help.

And….No matter how much it sucks, the patient needs to go through the process of trial and error.  The physician is required to start with the treatment having the LEAST RISK.  What does that mean??  Tylenol, ibuprofen, heat/cold, stretching,topical agents, especially if you are new to the MD–Americans often scoff at and ignore these things.  If you want to be taken seriously, you’ve gotta do it.  Once again, it’s part of being a responsible patient.  Keep track of these treatments and keep in mind–refusing to try the lesser options is grounds for the MD to dismiss the patient.  The doctor is saying “You won’t cooperate then I won’t treat you.”  That is the correct thing for the Dr to do.  Sorry.

Another thing:  Remain open to the concept of adjuvant agents for pain management.  Proper use of these medications allow the MD to prescribe lower doses of narcotics–which is the BEST thing for us as patients.  Do not interpret these steps as “being blown off” or “not being taken  seriously”.  Certain antidepressants are very helpful as tools against pain, so don’t assume the doctor gave you an antidepressant because he/she thinks “it’s all in your head”; that is not the case.  It is actually the opposite.  Follow this link for more information about adjuvant agents! This list is older and doesn’t include medications such as Lyrica, Cymbalta or Savella, but it’s short, clear & concise.  For information on the newer medications it’s best to google them separately to get the skinny on each one.

Other tips:

*Do not doctor-hop, doctor shop or get pain medications/controlled medications from more than one doctor.  This is a red flag; there is a difference between being poorly treated and not getting the treatment you want. Think long and hard before moving on.

NOTE: Most states have linked systems in place to see what your last controlled medication purchase was–who prescribed it, how much,when & where–so don’t lie.  You’d be amazed at how much the MD’s know about us when they walk into the room….

*Do not refuse the Tylenol, ibuprofen, toradol, inapsine  they offer initially.  The MD is working through the continuum of care–it is the appropriate thing to do–so cooperate.

*Do be responsible with your medications & keep them locked up at home.  If you lose them or they get stolen, be prepared to suck it up and do without.  If you have family members stealing your medications, REPORT THEM & LOCK THEM UP.  I did it-you can too if you love them.

*Do not come into the MD’s office with an idea half-researched and refuse to consider other options.  70% of the patients I see have only investigated the favorable aspects of their desired treatment and refuse to acknowledge the inherent risks.

*RE-EXAMINE your list of allergies and make sure they are true allergies.  I see multiple patients a week reporting “allergies” to all non-narcotic pain medications.  Funny that they are allergic to acetaminophen by itself but NOT in hydrocodone/apap.  (apap is acetaminophen). Patients (unfortunately)will not be taken seriously if the  “allergic reaction” is “It upsets my stomach, it makes my mouth dry, it gives me a headache, it gives me restless legs” or other similar mundane symptoms.  Those aren’t allergic reactions and it is perceived as drug-seeking.

I’m hoping my post offers some insight into the “other side” of pain management and helps patients understand the situation from another perspective.  The whole process is endless, especially when we’re sick or in pain–but it truly is the only process we have..


2 Comments (+add yours?)

  1. phylor
    May 05, 2011 @ 14:42:44

    Excellent points, especially now where doctors are more and more afraid of prescribing opioid medications. Your suggests will help folks come to the doctors more prepared and aware.
    Being able to describe the kind of pain you are experiencing is very important. I know it’s tough when everything hurts, but if you can be as specific as possible, it makes it easier for a dialogue with your doctor, and helps them prescribe what might be the best.
    I have nerve related pain that responded well to Lyrica; before that high dose opioids such as generic oxycontin and morphine were my only option. I was able to work with my doctor partly through keeping a detailed pain journal.
    For example, about 10% of the population get no pain relief from using fentyl patches. I’m one of that 10%. It was obvious from my need for stronger, and stronger patches, and my pain levels, that this just wasn’t working. So at that point, we switched to Lyrica to lessen the relance on opioids. And, in my case, it worked — Lyrica has dropped the level of my facial pain.
    Great and important post!


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