Pain brings more Americans to their doctors than any other complaint. Yet doctors can't just apply a pain monitor like they can check your blood pressure. How would you communicate your pain? It can be a challenge. Here are 7 tips for talking to your doctor about chronic pain.
What is Acute Pain?
Most all of us have experienced what pain experts call acute pain—pain that arises from a serious cut, an injury, a broken bone, appendicitis, a strep throat, and so on. Acute pain alerts us that something is wrong that we need to take care of. As the injury heals, the pain generally disappears.
What is Chronic Pain?
Chronic pain lasts three months or longer. It can persist for months, even years, sometimes after the triggering incident has long passed. Some chronic pain has no known cause.
As our population ages, the overall incidence of chronic pain increases with it, made worse by the opioid epidemic created in part by attempts to treat pain.
Health economists have estimated the annual economic burden of chronic pain as somewhere between $560 billion and $635 billion, more than the yearly costs for cancer, heart disease and diabetes combined.
That doesn't include the over-the-counter products, psychotherapy, and out-of-pocket costs pain sufferers pay for acupuncture, massage therapy, yoga, chiropractic care, meditation, hot and cold packs, herbal remedies, and other forms of nonstandard medical care that may help to alleviate some chronic pain conditions.
Chronic back pain is the leading cause of disability worldwide, with head or neck pain, arthritis, nerve damage, and cancer pain also very prevalent.
How to Communicate Pain to Your Doctor
Let's start with the basics. Like how in heck do you communicate the unique facts of your pain to your doctor—or, even to yourself?
Maybe you’ve had this experience during a medical or physical therapy appointment when pain is your main complaint. The receptionist hands you a clipboard to update your information, and along with it there’s a paper asking for information about your pain. It will show two-dimensional outlines (front and back) of a person and ask you to place an X where it hurts. Then you’ll answer a couple of questions and the page will ask you to rate your pain level on a scale of 1 to 10.
As you complete the paperwork, perhaps your internal monologue goes something like this:
Q: Where’s the pain?
Me: Here. But sometimes here. Or there when I move my arm. Sometimes all over, though some parts generally hurt more or hurt differently than others.
Q: When did you first notice the pain?
Me: I can’t remember, exactly. It’s sort of crept up on me.
Q: On a scale of 1 to 10, how would you rate your pain level?
Me: Which pain? When? What am I doing? Should I put down my running average?
Q: Circle the word or words that best describe your pain.
Me: Let’s see. It burns, stabs, aches, gnaws, throbs, flares, crunches, pinches, pulls, prickles, twinges, drills, bores, screams, shoots, stings, tingles, and cramps...though usually not all at once.
You feel compelled to scratch two or three X’s of different sizes on one of the figures to indicate the points of worst hurt and the order of pain intensity. You circle a few of the descriptive words. But before you even see the doctor (therapist, nurse, physician’s assistant), you feel like a failure.
Long-lasting pain is complex. It doesn't translate well into hard numbers or static charts. Often, people can’t find or don’t know the words to describe it.
And the pain scale can be simplistic and can lead to people getting inappropriate treatment for their pain.
7 Tips for Talking to Your Doctor About Chronic Pain
Don't just say, "I hurt all over." Think about how to describe your pain in words—lots of words, including flowery language and metaphors—and how to describe the ways that pain affects your daily functioning and quality of life.
However, since the average medical appointment doesn't allow much time for flowery speeches, and the average doctor interrupts or stops listening to a patient after 11 seconds, you have work to do:
- Spend time investigating your pain. Where is it located? Think about when you first noticed it and note whether it’s gradually gotten worse or stays the same.
- Pay attention to pain at different times of day and night. When is it worse? Think about it when performing different kinds of actions. Take some notes, maybe a lot of notes. For example, if the pain doesn't seem to have a single location or a consistent intensity, jot that down. If it moves around, gets worse or better with the time of day, the temperature, the seasons, or with certain activities, write down the specifics.
- Think about how the pain prevents you from doing what you used to do or want to do, what seems to make it worse, when and where it hurts more, what helps (or doesn't) alleviate it. Write it down.
- Don’t forget to include the ways the pain has affected your state of mind (e.g., “I have a hard time concentrating on my work.” “I don’t want to be around other people.” “I’ve started snapping at people.” “I feel hopeless.”)
- Write down everything you’ve done to try to lessen the pain, what’s helped and how much.
- Now collect your notes and boil them down to a single page of bullet points, maybe two. (By now you’re halfway to becoming a professional writer!)
- After the hello and your doctor’s sharing test results (if any), hand over your notes and plunge right in. “Dr. Goodwill, because I know we don’t have time for my whole story, here are some notes to add to my medical record that summarize my pain situation."
“Now I‘d like to tell you briefly how this pain is affecting my life and share my goals for managing both the pain and my life.”
Then begin talking. With any luck, you’ll get a few minutes in more than 11-second bursts.
Know What You Need Out of This Visit
Before you go, think about what you want to get out of your doctor visit. Remember that doctors will rarely ask you about your pain unprompted. And doctors cannot feel your pain. Since patients often downplay their pain, an honest pain conversation doesn't always happen. It's up to you to help your doctor (and yourself).
Besides bringing your notes (as discussed above) about clearly describing your pain, here are five questions that YOU might ask your doctor to answer:
- What do you believe is causing my pain?
- What scans or tests can diagnose my condition?
- Are there ways I can help my pain through diet or exercise or how I live?
- Are there treatments for me and what are the pros/cons?
- What are the different options and what are next steps?
Chances are you’ll find your pain-investigation exercise enlightening and useful, even beyond communicating with your medical professionals. It may help you understand, monitor, and even cope with your pain. Keep making notes.
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