Treating Chronic Pain by Patient Empowerment
When evaluating patients for chronic pain therapy, I always ask them at the initial consultation what treatment they have previously received. Many of these patients have been complaining of chronic pain for years to their physicians or other healthcare providers. Amazingly, the patients oftentimes respond simply “medications.” Incredulously, I will ask the patient, “You’ve only been taking medications?” to which they will respond, “Yes.” Patients also will occasionally say, “My doctor sent me to physical therapy for two years.” I will ask about this and find that the physical therapy had little-to-no benefit to the patient. Another favorite response of patients is, “My doctor sent me for lots of injections, including epidural steroid injections or facet injections.” I always ask if the epidural steroid injections worked and the response is almost invariably, “Not at all” or “Only for a brief while.” Unfortunately, many physicians regard pain management to consist solely of the prescribing of opiate pain medications. While I know that most pain physicians have difficulty believing this, but I think that a lot of our pain management practitioners suffer from a lack of vision that is caused by their procedure orientation. Unfortunately, I also believe that a lot of the procedural orientation that we see is driven by financial considerations.
Goals of Intractable Pain Management
In my clinic, I have as the goals of our treatment, the following:
- Tolerable pain control most of the time, as judged by the patient and the physician with minimal or no side effects from the medication.
- Improved function, as judged by the patient and physician.
- Improved quality of life, as judged primarily by the patient.
Our means of accomplishing these goals can be briefly stated as:
- Optimal utilization of opiate pain medications.
- Optimal utilization of non-opiate medications including, but not limited to, antidepressants, anxiety-relieving medications, anticonvulsants, muscle relaxants, sleep aids, and other unique medications.
- Learning, implementing, and utilizing pain reduction techniques.
I believe that patients definitely benefit from the utilization of medication, but I also believe that the primary goal of a pain management clinic should be to teach patients how and when to use pain reduction techniques. I also believe that it is very important that we empower our patients by providing them with the skills needed to no longer be a patient, but instead a person with chronic pain. I advocate that all of my patients join the American Chronic Pain Association (ACPA.org). The American Chronic Pain Association (ACPA) has a 10-step program that is utilized to transition a patient to a person. It is stated in their website that managing chronic pain is a journey that takes a patient to a person over time. It is noted that the isolation and fear that grows over time can overwhelm a person with chronic pain. In like manner, a return to a fuller, more rewarding life also takes time and is a journey with many phases. The ACPA describes these phases as 10 steps.
The ACPA’s 10 Steps For Moving Patient to Person
Step 1: Accept the pain. Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.
Step 2: Get involved. Take an active role in your own recovery. Follow your doctor’s advice and ask what you can do to move from a passive role into one of partnership in your own healthcare.
Step 3: Learn to set priorities. Look beyond your pain to the things that are important in your life. List the things that you would like to do. Setting priorities can help you find a starting point to lead you back into a more active life.
Step 4: Set realistic goals. We all walk before we run. Set goals that are within your power to accomplish or break a larger goal down into manageable steps and take time to enjoy your successes!
Step 5: Know your basic rights. We all have basic rights. Among these are the rights to be treated with respect, to say “no” without guilt, to do less than humanly possible, to make mistakes, and the ability of not having the need to justify your decisions with words or pain.
Step 6: Recognize emotions. Our bodies and minds are one. Emotions directly affect physical wellbeing. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.
Step 7: Learn to relax. Pain increases in times of stress. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualization, and other relaxation techniques can help you to better manage the pain you live with.
Step 8: Exercise. Most people with chronic pain fear exercise. But unused muscles feel more pain than toned flexible ones. Together with your doctor, identify a modest exercise program that you can do safely. As you build strength, your pain may decrease. You will feel better about yourself, too.
Step 9: See the total picture. As you learn to set priorities, reach goals, assert your basic rights, deal with your feelings, relax, and regain control of your body, you will see that pain does not need to be the center of your life. You can choose to focus on your abilities—not your disabilities. You can grow stronger in your belief that you can live a normal life in spite of chronic pain.
Step 10: Reach out. It is estimated that one person in three suffers from some form of chronic pain. Once you have begun to find ways to manage your chronic pain problem, reach out and share what you know. Living with chronic pain is an ongoing learning experience. We can all support and learn from each other.
The most important thing about these steps, in my opinion, is that we ourselves can teach our patients how to do these things. To best do that, we must learn them ourselves and incorporate them into our own lives. I believe that it is important that the pain management physician be a role model. We must learn how to do these pain reduction techniques in our own lives and then develop programs that we can share with our patients so that they can implement them in their own lives. There are a multitude of pain reduction techniques, but the important point to remember is that there is no formula or secret to these. In my office, I have developed numerous handouts that I give to patients that answer their questions about many different aspects of managing chronic pain using methods other than the dispensing of pain medications or other pills.
Every patient who leaves my office does so with not only prescriptions, but also recommendations about websites to visit, books to read, and things to do to deal with certain aspects of their lives that are impeding their control of their chronic pain. Areas that I cover in teaching pain reduction techniques to my patients include the following: