Chronic Pain
This Pain Isn't Going Away
Chronic Pain, an Overview
Unfortunately, the diagnosis of "chronic pain" is becoming more and more common across America.
Chronic Pain is defined by physicians as a cutoff of pain that lasts for more than three months. While breaking an arm or getting into a car crash can lead to severe pain, it is expected to resolve in the majority of cases and may be treated differently than "chronic" pain.
What Causes Chronic Pain?
While there are many theories about why we are experiencing the rise of chronic pain in this country, there is no one definitive cause. An increase in obesity (discussed more here) puts more stress on our joints, spine, and muscles. Certain dietary changes have been thought to increase inflammation in the body, making us more "sensitive" to pain.
How Do I Communicate About This with my Doc?
There is currently a stigma about chronic pain amongst physicians, and while this is evaporating slowly you may experience some disbelief or feel frustrated with your initial conversation. While aggravating, keep in mind that many physicians were not specifically trained to deal with this and are "learning on the fly." Ways you can get your point across without exaggerating or damaging your credibility are:
Making sure you know your history clearly. "I was in a car accident in 2015 in which these injuries occurred" is easier for doctors to understand than "I got messed up a few years ago"
Making sure that you describe your pain clearly. Stating that your pain is a "thirteen out of ten" demonstrates a lack of understanding and not a clear statement. Think of it this way: if you tell a fireman to rescue you from a burning building, saying that you're on the thirteenth floor of a ten-story building just muddies the water.
Making sure that you are honest with previous treatments and medications. Most doctors now check national databases which record controlled substances (pain pills, benzos such as xanax/ativan/klonopin, certain muscle relaxants). Contradicting this evidence will give the impression you are not being honest with your physician which will damage the mutual trust we hope to build.
So Am I Always Going to Be in Pain?
Chronic Pain, by definition, may not have a firm endpoint. From a doctor's point of view, while some issues can be "cured" many times chronic pain becomes an ongoing issue which can only be "treated" and minimized. Depending on your specific diagnosis, it may not be realistic for you to have a "zero out of ten" pain score, and your doctor may instead focus on making sure you are functional. This is a loose definition but means that even if your pain is three or four out of ten, you are able to wash and clothe yourself, go to the store, and hold a job.
Pain is a spectrum, and often the only way to eliminate it entirely is to induce unconsciousness to the point of needing a ventilator to breathe for you. Obviously this is no better than having your pain be completely untreated, as you still can't function in life. As a result the goal is to balance between sedation and pain.
I've Heard that Opioids (aka Narcotics, Opiates, Pain Pills, etc) Are Dangerous?
In December of 2011, the leading cause of "accidental deaths" in America stopped being Motor Vehicle Accidents and became prescription medications.
This danger is made worse by combination of pain pills as well as other controlled substances (sleeping pills such as Ambien, anxiety pills such as Xanax or Ativan, muscle relaxers). The government and pharmacies are creating more and more regulations for physicians which limit their ability to prescribe opioids in order to curb the "opioid epidemic"
What Can I Do For Myself?
To better help
Educate yourself about the way that Chronic Pain happens, how it works, and what can be done to reduce it and manage it with these free resources below.
Retrain Pain Foundation has a series of free short videos about how to think about these things
Brain Man has a free YouTube channel dedicated to various pain topics and ways to understand pain pathways and ways to live with chronic pain. This is a good first video.
For more detailed information, Stanford has a YouTube Channel dedicated to educating (both providers and patients)
For much more detail, MacQuarie University in Australia has a free online course of education about not only how chronic pain happens, but also how to manage it.
There are several resources which are not free, but can be helpful in managing distress from physical and emotional pain which often go hand-in-hand
The Headspace App is a series of guided meditation resources which can be used online or on your phone to restructure unhealthy thoughts. While some people dismiss this, meditation has been consistently shown to reduce pain scores and improve function in life.
There has also been increasing research in the field of "BioFeedback" - a method of regulating your breath, circulation, and even 'subconscious' effects such as heartrate and circulation. Many people state that focusing on a state of relaxation with immediate feedback can help them to sleep better, manage their pain more smoothly, and require fewer medications.
Ultimately these are things which need to be discussed with your physician. If you feel neglected, ignored, or mistreated you should either discuss these feelings with your doc to see if it's a misunderstanding which can be corrected, or find another doctor to get treated