According to the CDC, approximately 50 million people in the US are living in chronic pain. We all know about the opioid crisis, and this knowledge has done nothing to help alleviate pain many are suffering. Although we may all prescribe these addicting medications less often, opioids are rarely indicated to treat chronic pain anyway.
As a medical profession, we are not doing a good job managing chronic pain. Patients are often stigmatized when seeking treatment. Not all patients asking for pain medications are drug seekers. Sure, there are some, but we fail our patients with chronic pain with the knee-jerk reaction of assuming “drug-seeker” when we hear a request for opioids. We should hear what our patients are saying and try to determine the source of their pain.
One of the first problems we need to overcome when treating chronic pain is recognizing that pain is a symptom, not a disease. Instead of instinctively reaching for that prescription pad or e-prescribing tab, we need to ask why the patient is in pain: What is its cause?
Back pain is a common problem we see for which patients are often given medications like NSAIDs or muscle relaxants without a search to determine the underlying etiology. Not so long ago, I had a patient who saw several doctors and was prescribed medications to treat “sciatica.” Nothing helped the pain. It turned out that he had cancer that had metastasized to his hip bone and once he started cancer treatment, the pain got much better. We need to always be able to answer the question “Why is there pain?”
Another hurdle we need to address is unrealistic expectations. Patients see ads for all kinds of things—from CBD oil to Himalayan salt massage —that promise to make them pain-free. In reality, they may never become free of pain. The goal should be to maximize function while minimizing pain. We need to help patients understand that this is the attainable goal. Physical and occupational therapy are great tools to reach these goals, and we should be prescribing them. Helping patients make lists of goals is also helpful.
The emotional burden of chronic pain is often ignored. It is quite devastating to patients to not be able to do the things they used to. A grandmother no longer able to carry her newborn grandchild because of shoulder pain is horrifying to that patient. We need to treat the mental health consequences that often accompany these diseases.
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