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
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)
Pro golfers use visualization when they play. They picture the precise shot they want to hit before taking the club back – the trajectory, shape, roll and finish. This puts a positive image in the mind; the body then makes the motions needed to turn the image into reality.
We can do the same with our pain.
We can visualize a different way to view our pain and respond to it. We can visualize living well despite the pain. And we can visualize the pain leaving our bodies or the pain taking a smaller role in our lives.
Try these exercises
Find links to these and other self-management tools.
I was recently honored to be a guest on the Compass Opioid Stewardship Program podcast hosted by Dr. Rachael Duncan, PharmD. and Dr. Don Stader.
I'm so grateful for the opportunity and blessed to be able to share my story with clinicians. I'm also thankful for the generosity of Dr. Stader. You'll find out what he offered me at the end of the podcast. It brought me to tears.
You can listen to the podcast episode on Apple, Spotify, and Libsyn via the links below:
Check out the entire podcast series.
Learn more about the Compass Opioid Stewardship Program.