Discussing Pain With Your Doctor
I re-posted this blog on chronic pain and how to explain to your doctor what your pain is and where you are on the pain chart because this is my most read blog since I started in 2011. This tells me a lot of people suffer with chronic pain. Chronic pain is not the pain you feel from a sprained ankle or a bump on the head for that goes away. Chronic pain is different than acute pain which is high pain that happens from an injury, etc but can usually be treated.
“Chronic pain: Pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments. Chronic pain may be related to a number of different medical conditions including (but not limited to) diabetes, arthritis, migraine, fibromyalgia, cancer, shingles, sciatica, and previous trauma or injury. Chronic pain may worsen in response to environmental and/or psychological factors.” From: Medicinenet.com
My Pain doctor, who is trained to use all sorts of pain treatments like the Radio Frequency Ablation that I have had done on over 25 places 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. He told me he agreed.
When I first saw my pain specialist, 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 and degeneration of my vertebrae caused by osteoporosis, degenerative disc disease and joint disease 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.
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. I said it was like a weight scale and the number on the scale was high due to so many kinds of blocks of pain. 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 every six hours or 4 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-five 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. I did no dramatics because believe me when I tell you a doctor can tell when you are putting on dramatics for their benefit and they can tell 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.
If you go in and say in response to what is your pain level?…”My pain is a ten” and you walked in and even drove yourself 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. Use the actual numbers to explain and explain how it has impacted your life. For example, I am bed bound so it took away my ability to walk.
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, even Radio Frequency Ablation and spinal steroid injections, 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 lying 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. The exaggeration is the reason that so many doctors, especially pain management doctors, are requiring random urine tests to see if you are abusing the drugs.
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 by telling you about 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. Pain is hard enough to deal with that we have to make sure we do not exaggerate just to get them to listen.
This chart is awesome and even impressed my pain doctor. Read and and see where you really are. It taught me that 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”. I had a friend so upset because she found this in her charts and sadly, those words went to every doctor she went to after that.
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 pain without just taking another pain pill. I use self massage, heat, ice packs, visualization, distraction, meditation, etc. 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. And there are procedures they can do for back pain such as steroid injections and Radio Frequency Ablation. 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, a power chair, roll in shower chair, forearm crutches to get up to get in my chair, medicine boxes 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 am not bullet proof and I feel intense, chronic pain but I have just learned how to have a methodology for dealing with it with the help of my pain specialist.
I have the kinds of pain where on one hand, the muscle and joint/arthritis type pains require me to move them or the pain is worse. 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. I have different kinds of pain all combined and it is essential that we 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.
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 has helped my treatment by my doctor and helped my pain. If they ask for testing, do it because it is harder when you have no diagnosis to explain your pain.
As he says, if he can remove just one of those blocks of pain 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. We are a team and we talk about all the different “blocks” or kinds of pain so that we can figure out which one to work on. Helping just one area such as the neuropathy pain helps the over all pain.
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 by being able to talk calmly, your doctor can offer you treatment that helps control your pain better. But, we must remember that along with our doctor’s treatment and care, we must do our part to help make our pain better. And do not poo poo meds they want to give you. All pain is not helped by a narcotic. Some pain such as inflammation can be helped with a histamine blocker, some pain such as Fibro pain does not need a narcotic pain medicine but can be helped with things like Lyrica, etc. As I always say, survivors focus on solutions to the problem and victims just keep focusing on the problem without making any effort to help the situation.
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