We can be our own worst critics. It's important to remember there's still a core you despite the pain and to be kind to yourself..
What you can do
I love this metaphor about who's driving the car - you or your pain..
Things you can control - Focus on these
Things you can’t control - Don’t focus on these
If biomedical treatments like medicines, rest, supplements, ice, heat, injections, and physical therapy didn’t resolve pain when it was acute, is it reasonable to expect using only the same treatments to change our symptoms when the pain becomes chronic?
We must change the paradigm. Pain is more than a biomedical condition. We need to treat both mind and body. As Dr. Rachel Zoffness reminds us, " Because pain is biopsychosocial, treatment must be, too."
Comprehensive pain treatment that addresses the biopsychosocial aspects of a person's pain experience is not only more clinically effective than conventional medical treatment by itself, it’s also more cost-efficient.
Acute pain vs. chronic pain
There are two types of pain: acute and chronic.
Acute pain is the body’s normal response to tissue damage or injury. The pain matches the damage and treatment works - lasting less than three months.
Chronic pain is an abnormal response, becomes its own disease/condition, and doesn’t improve over time. It can happen long after an injury or illness heals. Treatments don’t always work or stop working and symptoms can change and grow over time.
The longer we have pain, the less likely it is related to tissue damage or injury and the better our bodies can become at creating it and turning up the pain volume. It’s a process known as central sensitization.
Sensitization can happen in all chronic pain conditions, no matter the underlying cause, including fibromyalgia, whiplash, shoulder pain, neuropathic pain, chronic fatigue syndrome, non-cardiac chest pain, irritable bowel syndrome, temporomandibular disorders, post-surgical pain, complex regional pain syndrome, low back pain, osteoarthritis, pelvic pain, and headache.
This 22-minute video from Dr. Sletten with the Mayo Clinic Pain Rehabilitation Center (PRC) does an awesome job explaining pain and sensitization, why traditional medical treatments don’t always work for chronic pain, and their approach at the PRC. I encourage you to watch it.
This is an excellent video from Dr. Christopher Sletten, Clinical Director of the Jacksonville, Florida Mayo Clinic Pain Rehabilitation Center (PRC) that is part of the FEATURED content in my Chronic Pain Champions - No Whining Allowed support group. (The Rochester, Minnesota Mayo PRC is the program I attended.)
Dr. Sletten explains:
Find links to the Mayo Clinic PRC and other programs.
Read about my experience at the Mayo PRC.
My article originally published December 30, 2019 in National Pain Report.
Chronic pain appointments can be difficult for both doctors and patients.
For patients, doctor visits can be intimidating and create anxiety. We want validation of our pain, empathy, answers, and support.
For doctors, chronic pain patients can be more challenging to treat than other patients. We can be demanding of their time, attention, and patience.
While they genuinely want to help, doctors often have limited training (typically only 11 hours of pain education in medical school); limited time (typically only 15-20 minutes per appointment); limited options due to government, health system, and insurance guidelines; and limited internal resources to treat chronic pain patients.
So how do you make the most of your appointment time and get the best treatment when you visit the doctor?
Below are 23 suggestions to help maximize the patient-doctor experience (thanks to the many ideas provided by members of the Chronic Pain Champions – No Whining Allowed Facebook support group):
Before the appointment
At the appointment
To get the best treatment from your doctor, be prepared, calm, engaged, insightful, and open to self-care. It’s harder for doctors to treat patients who are negative or expect the doctor to fix all their problems.
I hope you find these tips helpful.
Did you know?
As part of the week-long Mayo Clinic fibromyalgia program I attended in 2016, I met with a pharmacist to review the lengthy list of prescription medicines, over-the-counter medicines, and supplements I was taking at the time. My medicine cabinet looked like a GNC store.
I was instructed to bring the actual bottles with me to the appointment, so I packed the bottles into a gym bag (yes, I was taking a lot of medicines and supplements) and went to see her.
I was surprised as she read each bottle, making comments and recommendations about each pill – including product quality, labeling issues, ingredient safety, and dosing.
When the appointment ended, my medicine and supplement list was much shorter with her recommending stopping most of the supplements and my gym bag much lighter – throwing away the pills I was going to stop taking.
Unlike prescription or over-the-counter drugs, which must be approved by the Federal Drug Agency (FDA) before they can be marketed, the FDA doesn’t review supplements for safety and effectiveness before they are sold.
We don’t know where the products are made, how they are made, what is in them, and if the dosage is appropriate.
Safety is left up to the manufacturers and distributors of the supplements.
You assume all risks when using supplements. While some may be valuable, many aren’t.
Chronic pain can make it easy to feel overwhelmed, reduce our activity levels, and become isolated. Goals help restore a sense of order, build self-efficacy and sense of control, improve mood, and provide direction by helping with planning daily activities.
One of the tools we learned at the Mayo Clinic Pain Rehabilitation Center was goal setting to help us plan our days and keep us on track. We set goals each day. They didn't have to be massive, but they had to be SMART - specific, measurable, achievable, relevant, and time-bound.
Some SMART goal examples:
Did you notice none of the goal examples included pain reduction?
Our focus should be on reducing stress, improving our quality of life and increasing functional ability and activity, not pain reduction. Focusing on pain reduction is an easy trap to fall into - leading to frustration and depression. Just as the homepage of my website says - we can live well, despite the pain.
Pain is the body’s alarm system. It’s designed to protect us from danger just like a home security system or a smoke detector. It’s the body’s normal response to acute tissue damage or injury and heals in normally 3-6 months.
But what happens when pain doesn’t go away?
Once pain persists beyond the normal healing time, it becomes chronic - losing its warning function and becomes its own disease/condition. It’s an abnormal response (with or without obvious pathology).
Although all pain hurts, not all pain indicates damage. We know what to expect from our pain by the very nature of it being chronic or ongoing. It’s not like getting burnt, twisting an ankle, or getting stung by a bee that needs protection until the injury has heals. Of course, any unexpected new pain should be investigated.
Pain, stress, and tension are closely related. Muscles tighten and put pressure on nerves resulting in even more pain.
It’s possible to activate your body’s natural relaxation response to help reduce the tension using mind-body tools like:
FIND MORE TOOLS AND APPS
Pain rehabilitation goes beyond medicine and medical interventions – and crosses different disciplines. It doesn’t just focus on removing the pain. It focuses on the patient and how they can play a role in their own pain management.
It’s a proven approach based on the biopsychosocial model of medicine – benefiting patients while reducing costs and reliance on the medical system.
In addition to their general efficacy, these types of programs using interdisciplinary chronic pain rehabilitation can be effective at weaning patients off opioid therapy with long-term improvements in pain, mood, and function.
I was fortunate to be able to attend the 3-week interdisciplinary Mayo Clinic Pain Rehabilitation Center – not just once, but twice. It was both a game-changer and lifesaver for me. I highly recommend the program to anyone interested in taking an active role in managing their own care. Read about my Mayo experience in this article.
More programs like this are needed to shift the current reliance on biomedical therapy towards a greater reliance on provider-supported patient self-management and true biopsychosocial treatment.
Availability is important but so is accessibility. These programs aren't cheap, and insurance can be hesitant the pay the price tag. What payors need to remember is that these programs are cost-effective with a 68% reduction in medical cost spending.
Find links to programs in the U.S. and around the globe.
What to look for in a program
A pain rehabilitation program should focus on you as a person, not just your pain.
Interdisciplinary pain rehabilitation programs that take place in the same facility with health care providers working together with open communication and shared objectives are the gold standard of comprehensive care outperforming medical pain services and less coordinated multidisciplinary programs.
A comprehensive pain rehabilitation program typically includes:
Learn more about pain rehabilitation
Learn more about the Mayo Clinic Pain Rehabilitation Center (PRC)