Busy physicians lack time, and sometimes training, to help complex pain problems.(ISTOCKPHOTO)Good chronic pain treatment can be hard to find. A chronic pain patient has every right to believe that his or her doctor will listen sympathetically and prescribe the appropriate treatment, but that is not always the reality. Truth is, many doctors have not been trained to deal with the complex, changing area of chronic pain treatment. One 2001 survey of primary care physicians' attitudes toward prescribing certain medications found that only 15% said they enjoyed working with patients who have chronic pain.
This can lead to frustrating encounters at the primary-care level, especially if your doctor is rushed.
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Pressures on doctors
"Doctors don't want patients to suffer, they want people to get better," says Bill McCarberg, MD, founder of the Chronic Pain Management Program at Kaiser Permanente in San Diego. "But they feel stress, they feel time constraints, they have to deal with pre-authorizations, it's not the kind of practice they wanted. They're stressed, and that leads to moving patients along."
"As a doctor in today's medical system, it's difficult to deal with chronic pain conditions," agrees S. Sam Lim, MD, a rheumatologist at Emory University School of Medicine in Atlanta. "Most practices are forced to see a certain number of patients in a limited amount of time. [With chronic pain] it's not so simple as five minutes, a few questions, and handing out a pill. It takes some time. And our system isn't set up for that."
"The patient needs to realize that the doctor may not be able to discern what's going on in the first visit. Often it takes a few visits," says Dr. Lim.
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In 25 years of caring for her chronically sick husband, who was injured in an industrial accident, Ann Jacobs, 62, of Laramie, Wyo., has watched physicians struggle with the trial-and-error progress of his treatment. "Doctors are programmed for success stories," she says.
Meanwhile, because of its complexity, pain treatment has emerged as a separate, multidisciplinary specialty. That's good, but pain patients often need to get to a pain specialist through their primary care physicians.
Emotions can cloud the diagnosis
The emotional effects of chronic pain may also make diagnosis more difficult. Maggie Buckley, 46, from Walnut Creek, Calif., learned this the hard way. She suffers from Ehlers-Danlos syndrome, a rare genetic tissue disorder that leaves her with chronically painful joints.
"If you say 'it's really depressing and upsetting me, I'm in so much pain,'" Buckley says, "doctors will see it in terms of emotion and treat it as an emotional problem, referring you to psychiatric care or antidepressants." That is sometimes the appropriate treatment route, because antidepressants can treat chronic pain and there is a link between pain and depression, but you need to stand your ground and make sure any treatment is addressing your specific problems.
Be gentle about your pain, but be firm
It's important to be clear about your pain and explain the way it impacts your life when you're talking to your doctor. Don't be intimidated. Stand your ground, calmly.
"Patients really need to be persistent about their complaints in a way that is constructive to get across to the physician that this is something real," says Dr. Lim. "There are some physicians who are more open to listening than others. It may take a few doctors to find a marriage."
"You have to go very gently to start with," advises Ann Jacobs. "Listen to what the doctor has to say first." Then, if you're not satisfied, press harder. But remember that the most important thing is to create a relationship with your doctor in which you're a team, both looking for the best way to alleviate your pain. After he or she has assessed your needs, you can consider seeing a pain specialist.