If I ask patients how satisfied they are with their pain treatment, I think there’s an inverse correlation with whether they’re on opioids or not; and the higher the dose of opioids, the less satisfied they are. In general, I don’t think that they’re a great treatment. I think they’re reserved for a small subset and there’s a small subset that work well. I still think that the things that work the best are the things that I was taught when I was in training as a pain provider, which is ask the patient about how their life is different because of their pain, find out the things they can’t do, work on things you can correct, help them get their sleep back in order, help find strategies to work on their mood, help them think about and re-conceptualize the pain differently and decrease their fear of injury, find some way to get them to use their body. In general, when we give people pharmaceuticals as treatment, we’re taking away their role as an active participant in their healthcare. It’s better to find some way to get them to be more active in their healthcare and to view medications as an adjuvant to other treatments.
When you get in better shape, you have less pain. When you sleep better, your pain tolerance is increased; and when your mood is improved, your pain tolerance is improved and your pain experience is different. So what I would say is look broadly at your patient; look at their overall quality of life, their overall functioning, their overall mental health and think of ways to improve each of those things and turn the discussion from ‘I want to be pain free and escape and have no responsibility’ to ‘hey what can we do to partner together to get you to be able to do these things that are important to you’ because that’s how people make change and feel better.