Have you ever walked into your doctor’s office knowing exactly what you wanted to say and how you want to say it, but then they walk in and your mind just totally goes blank?
People with chronic pain have a hard time talking to their doctors about their pain, and often leave appointments feeling judged and unheard.
The latest numbers from the National Health Interview Survey show that around 50.2 million Americans (just over 20% or 1 in 5 of us) experience chronic pain either every day or most days.
Chronic pain affects everything from missed job opportunities and/or promotions to social invitations and important family gatherings. These miss opportunities often leave people feeling alone, misunderstood, and highly frustrated.
The War On Opioids
As of September, 2022, data reports that more than 3 million US citizens - and a total of 16 million individuals worldwide - have either suffered from Opioid Use Disorder (OUD) in the past, or are currently struggling with the condition. And it’s not entirely their fault. Companies like Purdue Pharma, Johnson and Johnson, Cardinal Health, and McKesson have all contributed financially to settle lawsuits linked to claims that their business practices helped to fuel this opioid crisis.
The opioid epidemic and the subsequent lawsuits that have emerged from it have helped to ensure that healthcare providers think twice before prescribing these products for those suffering from chronic pain.
Unfortunately the opioid epidemic also created a sense of stigma around chronic pain making it difficult for doctors to differentiate between those who genuinely required these pain medications to manage their chronic condition, and those who were seeking the medications for other uses.
The Stigma Around Chronic Pain
Patients who struggle with chronic pain conditions like low back pain often find themselves experiencing stigma around their care. It is especially prevalent for those who are being treated with opioids.
Research has found that patients receiving long-term opioid treatment for pain that is not related specifically to cancer face subtle (and not so subtle) stigmatization from a wide range of sources. The healthcare system, family, friends, employers, co-workers, and even society at large can leave people feeling as if they are outcasts.
If healthcare providers are to effectively manage these chronic pain conditions, a compassionate and empathetic approach is going to be needed in order to connect with patients and help reduce the stigma around chronic pain management.
Often people are made to feel guilty, judged and embarrassed when they reach out for help with their conditions and this can lead to feelings of depression and anxiety that can actually make their pain worse.
CDC Updated Guidelines On Opioid Treatment
In 2016 the Center For Disease Control (CDC) recognized that there was an urgent need for national guidelines around the issue of chronic pain management as well as the prescription of opioids for pain. They released the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. This guideline offered 12 recommendations for primary care providers around the prescription of opioids outside of active cancer treatment or end-of-life care.
The issuing of the guideline was well received and opioid use numbers dropped dramatically. Lawmakers from various states used the guidelines to create regulations and policies around the use of opioids which was initially very welcome. Unfortunately some of the policies that were created were inconsistent with the guidelines and went beyond the scope of what the CDC had originally intended.
No Opioids For Low Back Pain
Some cancer patients and palliative care patients ended up not being able to receive opioids for their condition. Others found that their medication was abruptly stopped and not gently tapered down. These measures left patients with untreated or undertreated pain and intense withdrawal symptoms along with psychological stress, and sometimes even suicidal ideation. This was obviously not what the CDC had intended for chronic pain sufferers.
The CDC then set about a new clinical practice guideline which was then reviewed by an independent federal advisory committee and included insights from patients, caregivers, and clinicians. These new guidelines still provide recommendations but there is more room for individualized care and patient-centered decision making rather than rigid rules that were a one-size-fits-all type of treatment.
What Do The CDC Guidelines Mean For Me?
Hopefully the introduction of the new clinical practice guidelines from the CDC give providers more scope to make personalized recommendations around pain. It is also hoped that the new guidelines are a step in the right direction to help reduce the stigma around the use of opioids and those who need them.
How Can I Talk To My Doctor About Chronic Pain
Now that the stigma aspect has been addressed, there are things that you can do to help your doctor have a better understanding about your personal experience with chronic pain.
When you meet with your doctor one of the first questions they tend to ask is for you to rate your pain on a scale of 0-10. “O” indicates that there is no pain at all, while “10” is generally regarded as indicating the worst pain you can imagine.
Unfortunately, this type of numerical rating often doesn’t do a good enough job of describing pain. Using a numerical scale is often too simplistic. Some patients might think that they can’t possibly use a “10” even though their pain is causing them significant distress. This could end up in a patient “low balling” their pain levels and not getting enough medication to properly address their pain.
And it's not just your comfort level that is affected - your treatment could be compromised. If patients aren’t receiving the right treatment for managing pain, they might not be able to keep up with their physical therapy exercises which can then make their recovery process much slower.
Different Types Of Pain Scales
Fortunately researchers have come up with several different pain scales that can help patients describe their pain more comprehensively to their doctors. Some of these scales include:
Numerical Rating Scale (NRS)
Visual Analog Scale (VAS)
Faces pain scales, typically the Wong-Baker FACES® pain rating scale
Scales like the VAS and the Wong-Baker FACES scale show faces that range from happy to crying which helps people put a more visual aspect to rating their pain. The more descriptive and accurate you are in communicating with your doctor, the better their understanding will be of how bad your pain is.
The Oswestry Low Back Pain Disability Questionnaire
The Oswestry Low Back Pain Disability Questionnaire is another useful tool that can help to create a more comprehensive picture of your pain experience. This questionnaire has been designed to give your doctor information about how your back pain has affected your ability to manage everyday life. Knowing if walking is difficult but possible, or simply completely out of the question, can help your doctor find a pain solution that is tailor made for your situation.
What Sort Of Pain Treatment Options Are There Other Than Opioids?
Fortunately research is providing doctors with a multitude of pain reducing options that do not involve medication. Some of these treatments include:
Cognitive Behavioral Therapy (CBT)
Chiropractic Care/ Spinal manipulation
We are seeing more and more evidence surrounding what is known as the ‘biopsychosocial approach’ to pain management and care. By taking into account the psychological condition and the emotions and stress levels that a person is feeling, doctors are able to help lower those stress levels and reduce feelings of pain. This model is becoming more widely used as the evidence behind it grows.
Chronic pain can have a devastating impact on quality of life and it is important that patients are given the chance to really describe their symptoms without fear of being judged or stigmatized.
Treatments like biofeedback, physical therapy, and cognitive behavioral therapy have been proven to help patients manage their chronic pain without the use of dependence-producing medications.
Doctors need to check their own biases when dealing with chronic pain patients and make sure that they listen properly and openly so that patients can feel heard and can properly describe their pain for the best possible treatment outcomes.
If you are struggling with chronic pain, make sure that you use tools like pain scales to help you describe your pain. If you don't feel like you are being properly heard, don't be afraid to find someone who will listen to your concerns and help you find the best treatment.