| One-Minute Clinician

Chronic Pain: Accepting an Imperfect Solution

There are number of problems for patients who suffer from chronic pain, and one of them is frustration with the treatment outcome. We in healthcare want to be the heroes, we want to be the fireman who’s going to rush in, break down the door with the axe and pull people to safety, and I think that comes out in the messaging that we give patients. Patients know that when they go see somebody for the treatment of their pain that their goal is to have no pain.  But the further along in the continuum you go in the chronic pain chronology, the less likely that becomes.  And unfortunately, that hero mentality from the healthcare provider, coupled with the patient expectation of the treatment goal being no pain, results in a misalignment that sets the stage for frustration, perhaps for doctor shopping, where people bounce from healthcare provider to healthcare provider because of their expectations not being met. Pain management is one of the few situations where a patient needs to have a say in what a successful treatment outcome is. I think the communication that could be made to patients with chronic pain is that our goal is not necessarily to get that pain down to zero. Our goal, as providers, is to help you negotiate a balance between pain and function, and help you achieve the best balance that’s possible for you, taking into account your clinical condition, your functional goals, your age, your place in life, et cetera.  Unfortunately, the patient’s expectation of zero pain and the hero mentality of the healthcare provider may lead to unrealistic goals and unrealistic expectations which never get reached.

And whether or not people are willing to admit it, there is a clock ticking.  The longer the patient goes, the worse the outcome can be.  The human body sets up these little channels to deal with the current now and that could make their pain much, much more difficult to treat. So it’s really all about communications between healthcare providers and patients and identifying the fact that in many cases, the solution will not be perfect.  Everybody wants a perfect solution, but not everybody gets one. With respect to primary care, I think we need to do a much better job of integrating education about how to treat patients in pain for the non-experts, so it becomes second nature for them. If chronic pain occurs more frequently than hypertension, cardiac disease and diabetes combined, then as far as I’m concerned, pain treatment deserves at least as much airtime as those medical conditions get. I think one way to attack the problem is to figure out how to make the people who attend PAINWeek, the people who attend the PAINWeekEnds, the people who receive the PAINWeek Journal, become the vectors for spread. I would love to see the 2300 people who attend PAINWeek become the champion, and have each one of them reach another 25, 50, 100 people and spread the word.  This does happen in medicine, I think it needs to happen in pain management.  That’s the path to success, I think.

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