Halt The Hurt: Coping With Pain

At least 34 million Americans suffer from chronic pain caused by conditions including arthritis, lower back problems, neuralgia, or migraine headaches. Some 15 million working Americans have pain on a chronic basis.

Having injured my back this summer, I have come to learn a lot about pain firsthand. Pain can be hard to define. It means different things to different people and your own perception of pain can change over time. For some people, acknowledging pain is a sign of weakness. What most people don't realize is that pain is a medical problem -- and that it can be treated.

How do you measure your pain?

It is difficult. No lab tests or X-rays can convey to your doctor what you are feeling. But even when pain is intense, many people struggle to find the words to describe it to the doctor. It is important to understand whether you suffer from acute or chronic pain.

Acute pain is not related to an ongoing condition and declines when you recover from the illness, injury, or surgery that initially caused the pain. Acute pain usually lasts for no longer than it takes to heal.

Chronic pain is constant or recurrent and is caused by a long-term condition (arthritis) or a progressive illness (cancer). Chronic pain lasts for months -- and it may last a lifetime. Chronic pain takes a psychological as well as a physical toll. It can lead to anxiety, anger, depression, and insomnia. Chronic pain sufferers may find it difficult or impossible to work and hard to do the things they once enjoyed. Chronic pain can even disrupt a person's relationships with family and friends.

Let's consider some of the more devastating psychological effects of chronic pain:

  1. Loss of mobility. Chronic pain and suicide ideation have been shown to be strongly related. However, recent research shows that chronic pain is usually a secondary cause of suicide ideation. One of the chief intermediary factors is the severe effect that chronic pain has on limiting mobility. Being unable to move around comfortably, constantly being constrained by pain, being unable to enjoy normal sexual relations with one's spouse or carrying one's children without fear of injury leaves a damaging mark on the sufferer's emotions.
  2. Depression. Patients with depression are also heightened in their perception of pain, and will very often be reluctant to carry out treatment modules provided to them for fear of encountering more pain. The combination of immobility and depression leads to irritability, nervousness (or anxiety) and an unhealthy desire for isolation. Marital conflicts develop and escalate. As depression sets in, chronic pain patients tend to become angrier, easily frustrated, often moody, and plagued with feelings of hopelessness.
  3. Sleep Disturbances. Chronic pain also influences the amount of sleep the patient is able to get. Difficulty falling asleep and early night awakenings both contribute to progressive depression, lethargy, and poor memory (especially vigilance tasks). The last effect, that is, the decline in vigilance due to sleep loss often presents other problems, such as proneness to accidents.
  4. Medications. Medications that limit the effect of pain may also produce nagging side effects such as gastro-intestinal problems or excessive sleepiness that create further irritation. In addition, some patients become dependent on painkillers to sleep or function throughout the day. Although there is evidence that narcotic drugs prescribed to chronic pain patients do not produce physical dependencies, these dependencies are often not biochemical but psychological. In addition, the patient may develop a tolerance to pain medications that are consistently prescribed.
  5. Anxiety. Pain may also include anxiety disorders because of increased muscle tension or spasms. Tension headaches, post heart attack pain and other pain syndromes affecting the musculoskeletal system may occur. Patients injured in motor-vehicle accidents often suffer flashbacks of the accident, frequent nightmares, fear of driving or crossing the street, and extreme anxiety when returning to the site of the accident.

What do you need to tell your doctor?

  • Where is the pain and how long have you had it?
  • How bad is your pain? Use descriptive words to explain it to your doctor: is the pain a throb, an ache, a burning sensation, or a tingle? Is it constant or does it come and go? What triggers it?
  • What do you think caused your pain? Tell your doctor about any injuries, illnesses, or activities that you believe are related to the onset of the pain.
  • What medications or other pain-relief methods (including alternative or herbal therapy) have you tried? How effective have they been?
  • Besides this pain, what other medical conditions do you have? Are you taking medications for any of these conditions?
  • How has the pain affected your daily life? Be sure to describe the emotional changes in your life as well as the physical ones.

Pain patients often encounter numerous obstacles in their attempts to find a healthcare professional educated on current clinical thinking in pain management, pain assessment, and pain treatment. What should frustrated patients do? Be aggressive and, above all, educate yourself so you know the right questions to ask.

Some suggestions:

Become an effective advocate

  • Learn what concerns your doctor. One pain specialist advises patients to open a dialogue with the physician -- without getting confrontational. Say, "I get the idea that you're not comfortable about managing my pain." If he or she acknowledges discomfort, ask to be referred to someone else.
  • Describe your pain in ways a doctor can understand. Put a 1 to 10 number on it. Use descriptions such as sharp, stabbing, dull, aching, burning, shock-like, tingling, throbbing, deep, pressing.
    Find a doctor who can help
  • Think of pain as a specialized problem which requires a doctor focused specifically on pain issues. In this type of scenario, your primary care doctor may refer you to a pain specialist for specific treatment -- but you will then go back to your primary care doctor once the situation is under control.
  • Some pain advocates advise changing doctors if your pain remains uncontrolled even after you've tried to discuss or explain the situation to your physician. Advocates suggest networking with other patients to learn which doctors are up-to-date on pain management. Learn about local pain clinics or pain specialty practices. Many larger medical centers have professionals who specialize in pain.

Know your rights

  • Having your pain adequately relieved is now an official patient right in many healthcare settings. The Joint Commission on Accreditation of Healthcare Organizations, a body that reviews standards of care, has started a process that requires all hospitals and nursing homes to specifically ask patients about their pain, assess it and make a plan to treat it, or risk losing accreditation.

Educate yourself

  • Learn about your disorder and then start to network by joining a support group for people with your condition. Or learn through organizations' websites and chat rooms.

Make a pain-relief plan

  • Work with a doctor to create a specific plan for you and set realistic goals.
  • Explore non-drug, non-surgical relief, such as massage, relaxation, meditation, exercise, cold and heat treatments. They may not take away your pain completely, but can often lessen the effects.