Taking Charge of Your Pain: What You Can Do to Stop the Hurt

Peer Reviewed
The Dilemma of the Chronic Pain Sufferer
If you suffer from chronic pain, you probably have discovered that searching for effective relief can be frustrating and time consuming. You may have encountered additional difficulties in convincing others - including not only health care providers, but also friends and loved ones, that your complaints of pain and suffering are real. Knowing when or where to turn for satisfactory treatment need not be futile, but you need to have appropriate knowledge in order to make the right decisions that meet your physical and emotional needs.

From Doctor to Doctor
Take for example a 49-year-old female patient of ours who was extremely successful before she was involved in a motor vehicle accident that caused chronic back and neck pain. Her whole life was turned upside down, and she was unable to work or take care of her family. She spent the last 5 years going from doctor to doctor trying to find some relief but few took her complaints seriously. She had lost a great deal of self-confidence, and she doubted her own self worth as a mother, a wife, a friend, and as a person. This might sound like the story of someone you know. Perhaps it even sounds like something you are experiencing. In this article, we will relate how chronic pain sufferers such as this patient can, by becoming educated consumers, take charge of their health care, overcome barriers to effective pain management, and begin functioning again.

Chronic Pain is Not in Your Head
We have found that a major obstacle to receiving successful pain treatment is that many chronic pain sufferers lack credibility with others, including health care professionals and insurance company representatives. This is because you can't actually see pain or measure and confirm it by a test like taking your blood pressure or getting an x-ray. A pain sufferer has to rely on his or her own word to convince others of their plight. As a result, many chronic pain sufferers are unfairly labeled as lazy whiners who exaggerate their complaints or, even worse, as malingerers who intentionally make up their pain. Some of our patients have related that because their x-rays or other tests looked "normal", a physician or a psychologist had tried to convince them that their pain was not real but rather "psychogenic", that is "in their head." Obviously, these labels can make it very difficult to access appropriate care.

Chronic Pain Different from Acute Pain
Why are medical tests often times "normal" or "non-definitive" in chronic pain patients? This is because in chronic pain there frequently is no obvious evidence of injury because the healing process has ended. This is different from acute pain, which is pain from a recent injury in which the body's attempt to heal is not yet finished. Following a recent acute injury it is easier for people to appreciate your pain and suffering and to empathize with you because there is observable proof of injury such as bruising, scabbing, swelling, the presence of blood, and bandages, splints, or casts. By the time pain becomes chronic, however, the typical signs of injury have resolved. Bruising and swelling, and bandages and casts have long since been removed. Once the visible evidence of injury is gone, most people assume that you have recovered and they expect you to go on with your life again as before. This misperception is likely because most people do not have personal experience with chronic pain and, as such, do not appreciate that chronic pain unfortunately can persist despite the body's attempt to heal itself and despite no obvious or visible evidence of injury or underlying disease. This can happen because the body cannot always fight disease effectively or repair itself successfully.

A lack of this understanding can lead health care providers to underestimate your true needs and this can result in your receiving inappropriate treatment or undertreatment. Frustration and stigmatization can erode your self-confidence and make you feel increasingly isolated from your friends and loved ones. We have seen many patients trapped in this vicious cycle of vulnerability experience degrading personal relationships and self-esteem, moodiness, loss of income, unproductive treatment, and relentlessly worsening pain and disability. A terrible irony is that this unfortunate outcome is avoidable with appropriate care.

Why Chronic Pain Management Sometimes Inadequate
Modern medicine's many spectacular successes in disease control have raised our expectations about the medical care we receive generally. Unfortunately, however, many people's expectation that they should receive excellent pain management remains unfulfilled. Ironically, although modern advances in pain control can help most chronic pain sufferers enjoy satisfactory relief, there is an important reason why pain management often falls short on its promises. While teaching programs for health care professionals, including physicians, generally teach acute pain management well, very few teach anything at all about chronic pain management. Training in chronic pain management is generally provided only to the relatively few physicians who seek specialized pain management fellowship training following medical school. Unfortunately, due to this lack of training, many physicians do not appreciate the differences between acute and chronic pain and that effective treatment requires different methods. Many health care practitioners, as well as patients, are also unaware of the pain management resources available. The field of pain management is growing primarily to meet the needs of chronic pain sufferers but this growth is still in its infancy. We have a long way to go until everyone who has chronic pain does not have to experience frustration trying to obtain adequate pain management.

Pain Management Professionals and Improved Training
We believe that better pain management training can help to avoid situations where patients become undertreated with pain medications. Take for example the plight of an elderly grandmother living in a nursing home whom we encountered with uncontrolled chronic pain from cancer. She had become undermedicated because of her nurses' misunderstandings regarding the appropriate dosing of opioid pain medication prescribed by her physician. Her nurses were well meaning but felt afraid of losing their licenses by following the prescribing physician's pain medication dosage because they considered the dosage to be "too high." The nurses did not understand that you can treat chronic pain, including cancer pain, safely and effectively with higher doses of an opioid pain medication than what is oftentimes required for acute pain. On the other side of the coin, we recognize that there are well-meaning physicians who prescribe pain medications without fully understanding the nature of chronic pain and then encounter addiction problems: Take the example of Elizabeth Taylor who became very vocal in the Los Angeles community about the addiction problems she encountered due to taking prescribed pain medications.

Updated on: 12/10/09
David S. Bradford, MD
The authors identify an important patient management issue for all physicians treating spinal disorders. Chronic pain is distinct from acute pain, both in neurophysiologic mechanisms and in prognosis for spontaneous resolution. The effective management of chronic pain requires a comprehensive program that incorporates pharmacologic care with behavioral and physical rehabilitation. At the University of California San Francisco, we approach chronic pain with a multidisciplinary approach, combining resources from our pain management center, physical therapists, mental health professionals, and pharmacists. An important issue in management of chronic pain is access to trained practitioners who are knowledgeable of the multifactorial etiology of chronic pain, and able to respond with multidisciplinary expertise.