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Discussing Pain With Your Doctor

This is the second time I have written on chronic pain and how to explain to your doctor what your pain is, where you are on the pain chart. Unfortunately, doctors do not explain pain charts well. Most are simply faces indicating faces ranging from half smiling to grimacing and that might be alright for someone with a sprained wrist or twisted ankle but for those dealing with chronic pain, it is not enough as the pain goes on past the week or two of an injury.

My Pain doctor, who is trained to use all sorts of pain treatments like the Radio Frequency Ablation that I have had more than once on my spine, came in and sat down the first day to talk to me and wanted me to explain all the marks on the body picture they had given me. I told him that it was very hard for a person with chronic pain to use a picture like that with the directions to mark where you pain was as if it were just one kind of pain or in one place.

I had marked many areas and as I explained each area to him, he sat looking at my records nodding, we went through the spinal pain from stenosis of the spine, degenerative disc disease and degeneration of the spine, to the inflammation pain of osteoarthritis, osteoporosis, sarcoid arthritis, psoriatic arthritis, to the muscular pain from fibro, to the nerve pain from neuropathy, to head pain from the swelling of the occipital nerve, even to  seizure pain. There was no way that I could mark one or two places on my body and say that is it. And he agreed. He is an awesome doctor and all my records and tests confirmed all that is wrong with me.

I went on to explain that to me, pain like I have with all the different kinds is cumulative and each one made the pain of the others worse. He just smiled at me and said “exactly”. I explained that I used many alternative ways of dealing with pain for I am not a big believer of narcotic pain pills even though I have to take them. And that is one thing I am very strict about. If it says to take six times a day…I do not take more because I am only hurting my self. I use other things such as distraction, visualization, heat, cold, massage, etc.  If you keep adding higher and higher narcotic pain pills, the day will come when none of them work anymore and then what will you do?

He just smiled at me and told me I had such a great concept of what chronic pain really was and he was not used to that. I told him that when you deal with it for over thirty-two years, you learn along the way. They tried me on morphine once and almost killed me because it lowered my respiration too low. That is when I learned I better be proactive with my own pain and use the skills to help make my quality of life better and not just lay there crying about how much I hurt.

I explained to him how my pain was affecting my life. No dramatics because believe me when I tell you a doctor can tell when you are putting on dramatics for their benefit, when you are crying or screaming or exaggerating to try to get them to believe your pain is worse than it is. They can tell if you are as weak as you say, or if you can not really walk, or if you are bed bound, etc.

And if you go in and say in response to what is your pain level?…”oh my pain is a ten” and you walked or wheeled in there…they know your pain is not a ten for a pain level of ten is so severe that you pass out from it. And if you go in there and say “oh my pain is a 12 or a 15 or a 30, you have automatically placed yourself in the “fake” category. Learning how to accurately tell your pain will help you best convey to your doctor where your pain really is and then they will listen to you and be able to help you.

Doctors are beginning to not want to use narcotic pain pills and use other medicines instead such as muscle relaxers, seizure medicines, anti-depressant, physical therapy, acupuncture, whirlpool, etc to help with the pain and we have to be partners with our doctors and do our share of alternative things such as stretching, walking, and taking best care of ourselves to help ourselves. It is no longer a patient laying in a bed waiting on the doctor to fix it all. We have to be responsible for ourselves and be our best health advocate.

I came across this pain chart and it is one of the best I have seen. It teaches you to explain how your pain is affecting your life. I can tell you from experience, that being totally honest is the only way to do this. Do not exaggerate your symptoms just to get more pain pills or to try to convince them that you are worse than you are for doctors are smarter than you think and you are only hurting yourself and your treatment.

If it is limiting your activity, then tell your doctor that. If it is making it where eating is impossible, tell your doctor that. And let me explain…after I had kidney surgery in 2007, I was in such horrific pain that I lost I think it was 34 or 36  pounds in 30 days. If you go in and tell your doctor that you can not eat from pain and you have not changed in weight or looks of weight, then you risk making them think you are faking.

painscale

pain chart from

http://www.tipna.org/info/documents/ComparativePainScale.htm 

This chart is awesome and even impressed my pain doctor. Read and and see where you really are. It taught me that saying a pain level of 5 was not as minor as most people think it is. Many people think they need to say a higher number to impress on the doctor that they are hurting and when a doctor observes you, they can judge if you fit in that number or not. They watch you even when you think they are not and many times you will think you have them convinced of your pain and you will find later in your chart “patients appears to be in no real distress”.

Read a pain level of 5…strong, deep, piercing pain. That is not minor. Try to relate in an honest way what your pain does to your life. And explain what other alternatives you have used for pain besides pharmaceuticals. I use many things to help my med and not pop another pill. There are also other medicines used to help with pain such as Lyrica, Nuerontin and other medicines that have to do with seizure disorder and even some with anti-depressants for fighting chronic pain can cause depression. A good doctor will use all sorts of treatments rather than just a pain pill.

Many of you know what my health is and that most of my life is in a hospital bed on a gel mattress prescribed by a doctor and using oxygen, power chair, roll in shower chair, forearm crutches with a box with so many prescription medicines that it is not funny and a pain level with narcotic pain pills that never ever goes below a 5 and hovers at a 7 and sometimes 8 a lot of the time…with strong pain pills. And you know that I believe in combating it with a positive attitude and still seeing the joy in my life but knowing how to talk to your doctor about pain was the biggest help in the world for me.

I have the kinds of pain where the muscle and joint/arthritis type pains…if I do not move and exercise them..the pain is worse and then I have the nerve type of pain from neuropathy, where moving increases the pain and I have learned to adapt and work around to try to find the best for me where I can handle the pain a little easier. I have learned stretching exercises to help ease the arthritis pain and I make myself get up and stand to improve circulation. We have to be the one in charge of how we deal with our health. We might not can change our health but we can change how we deal with it.

But knowing how to talk to my doctor and explain my pain and what it was doing to me in a calm manner and having him know that I was not drug seeking but was honestly in pain and had a lot of different types of pain has helped my treatment. Having the testing and documentation to prove what is wrong with me also has helped. It is harder when you have no diagnosis to explain your pain.

As he says, if he can remove just one of those blocks for a little while, then it will make the over all pain better and he is right. The RFA on my spine has helped me sit up again and sit in my special power chair with the gel seat and soft molded back to support me with less pain. And to have my doctor tell me that he knows when I tell him I am hurting, that I really am and he has no doubts about me being honest about my pain is the highest honor he could give me. Of course, having my records and seeing what is wrong helps a lot too.

I hope this chart and learning how to tell you doctor what your pain is doing to you and how it affects your activity and quality of life helps you talk to your doctor in a manner in which he or she will listen to you and offer you treatment that helps control your pain along with you doing your part to help make your pain better.

May 14, 2013 - Posted by | Uncategorized | , , , , , ,

6 Comments »

  1. […] Discussing Pain With Your Doctor (workthedream.wordpress.com) […]

    Pingback by When I Didn’t Think It Could Get Any Worse, It Did! | Julie's Spoonful of Sugar | July 1, 2013 | Reply

  2. This is a great chart! I am going to take to my pain doc and suggest he use this in his per visit pain scale we all have to fill out. I think if patients knew what docs think about pain and both could get on same wavelength those of us with chronic pain could be weeded out nicely from the bunch just seeking drugs. I know I’ve put a 10 on my pain scale, not realizing what the doc would see it as. Really according this chart, it would have been 7 pushing an 8.

    Thanks for your lucid and well thought out description of what pain really is and how to approach the pain doc. :) May your pain go away one night and never come back letting you live a more normal life. Miracles do happen! Hang in there.

    JJ

    Comment by khiba1 | May 26, 2013 | Reply

    • I am glad you liked it. I did not create it. Take the link where it came from with you. The people who did talk about the problems that patients have with a smiley face and not knowing what it means. Yes, I learned that my pain was a 7 or 8 and not a ten from this also. :) I pray your pain leaves you too and never returns. :)

      Comment by danLrene ©2011 | May 26, 2013 | Reply

  3. […] Discussing Pain With Your Doctor (workthedream.wordpress.com) […]

    Pingback by Chronic Pain and Its Affect On Quality of Life | A Path To Recovery | May 15, 2013 | Reply

  4. Thank you for the chart and in-depth explanation – this should really help me on my next doctor’s visit when we talk about pain management for my chronic pain and multiple health issues!

    Comment by Julie Catherine | May 14, 2013 | Reply

    • It helped me Julie…and for me to finally give a number that indicated by the pain chart how I was feeling and not the pain dictating that no no..5 or 6 or 7 is not high enough….and how to explain how it was making my life worse.

      Comment by danLrene ©2011 | May 14, 2013 | Reply


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