Mar 11, 2011 4:32 PM
One of the hardest things about chronic pain is that only you know how bad the pain feels. There's no blood test that can show much you're suffering. There's often no outward sign, like a bandage or a cast. There's just the pain.
"Pain is always personal," says F. Michael Ferrante, MD, director of the UCLA Pain Management Center in Los Angeles. "It's invisible to other people looking at you -- and that can lead to a lot mistrust and difficulties in relationships."
Whether you have low back pain, or migraines, or nerve pain, people might not understand or believe what you're going through. That suspicion might not only be shared by your in-laws or your boss, but even your doctor -- and that can have serious repercussions, preventing you from getting the pain treatment you need.
To get good control of your chronic pain -- and your life -- it's not enough to tell your doctor it hurts. You need to learn how to talk about pain: how it feels, how it rates on a pain scale, and how the pain affects you.
Everyone feels pain differently. Some people have conditions that should cause great pain, but don't. Others have no sign of a physical problem, but are in great pain. Your level of chronic pain can't be assessed in a scientific test or screening.
To help compensate for this problem, many doctors rely on pain scales to get a more concrete sense of a person's pain. You might have seen a pain scale in your doctor's office before. One common type shows a series of numbered cartoon faces moving from 0 (smiling and pain-free) to 10 (weeping in agony.) A doctor would ask a person in pain which face matched up with what they were feeling.
They might seem simple. But pain scales have a lot of good research behind them, says Steven P. Cohen, MD, associate professor in the division of pain medicine at Johns Hopkins School of Medicine in Baltimore. As chronic pain has shifted from being seen as a mere symptom to a serious condition in itself, pain scales have caught on as a tool to evaluate and monitor pain. While they're helpful for anyone in pain, they're crucial for some.
"Pain scales are especially important for people who might have trouble communicating clearly," says Cohen. That could include children and people with cognitive impairments.
Of course, one inherent problem with using a pain scale is that it's still subjective. A stoic person might describe their pain as a 2 on the pain scale, while another person would describe the same pain as a 6.
For a doctor to get a good sense of your chronic pain, just pointing to a single face or number isn't enough. Your doctor will need some context, says Seddon R. Savage, MD, incoming president of the American Pain Society and an adjunct associate professor of anesthesiology at Dartmouth Medical School in Hanover, N.H.
"I ask people to remember the worst pain they've ever experienced in their lives," Savage tells WebMD. "It might be a kidney stone or childbirth. That level of pain becomes the benchmark to which we compare the current pain."
She then tells people to evaluate their pain over the last week and asks them to assign a number to their pain at its most severe, its least severe, and its typical level.
"I also ask people to show me on the pain scale what an acceptable level would be," Savage says. "The fact is that we probably can't bring chronic pain down to zero. But we can aim for a level that still allows you a good quality of life."
Pain scales are especially helpful as a way to monitor pain over time, Cohen says. By using the same scale consistently with the same person, a doctor will get a good sense of how your pain is progressing and how well your treatments are working.
Your doctor needs to know not just how much the pain hurts, but how the pain hurts, says Savage.
The kind of pain you're feeling can say a lot about the cause, experts say. Cohen says that pain that's caused by tissue injury -- like arthritis or a back injured while shoveling snow -- tends to be like a dull ache.
But nerve pain, which could be caused by many conditions, ranging from diabetes to sciatica, typically causes a more distinctive shooting pain. Others describe it as burning, buzzing, or electrical pain. Nerve pain is also associated with other sensations that aren't painful in themselves, like tingling or numbness, Cohen says.
Savage says that it's also important to discuss any variations in your pain. How does it change during the day? What makes it hurt more? What makes it hurt less?
When you see a pain expert, go in prepared. Be ready to describe your chronic pain, as specifically as you can, along with details about when the pain started. The more information you have, the easier it will be for your doctor to help treat your pain.
Beyond the severity and the type of chronic pain, there's a third factor you need to discuss. "It's really important to talk to your doctor about how your pain affects your life," says Savage. It's a crucial and often overlooked detail.
When a person comes into a doctor's office complaining of chronic pain, many doctors focus only on the cause. Obviously, treating any underlying condition or disease is important. But your doctor also needs to focus on the symptom that brought you into the office: pain.
Savage says that you should think about the specific ways your chronic pain is affecting you. Does pain wake you up at night? Has chronic pain made you change your habits? Do you no longer go on walks because the pain is too severe? Has it affected your performance on the job -- maybe even putting your ability to work in jeopardy?
Giving specifics about how your chronic pain is impinging on your life and changing your behavior is key, Savage says. "It helps your doctor understand how much you're suffering and appreciate the pain as a problem that needs treatment," she tells WebMD.
Often, chronic pain is really more than just pain; it's a constellation of related symptoms and conditions. You might need treatment not only for the pain, but for the underlying cause. You might also need treatment for other problems that developed as a result of your pain -- sleep problems, depression, anxiety, or secondary pain.
"Treating chronic pain is not as simple as taking a single medication," Savage says. "It's more of an ongoing process." To control pain, it often takes a number of different experts working together. That could include your GP, a pain specialist, a physical therapist, a psychologist or psychiatrist, other specialists -- and you.
"The patient is really the most important member of the team," Savage says. While doctors can offer possible treatments for your chronic pain, only you can tell how well they're working.
"Patients who have the 'fix me, Doc' idea tend to do poorly," says Ferrante. Instead, you need to take an active role in your medical care. Be ready to talk about your chronic pain and how it affects you -- and be prepared to advocate for yourself, even in the face of doubt.
"You can't listen to the people who doubt the pain you're feeling," Ferrante tells WebMD. "You can't give in to their negativity. You must have faith in yourself and keep trying to get the right treatment."