Communicate about pain
DEAR DR. ROACH: What is the difference between chronic pain and acute pain? How can I best describe my chronic pain when it is variable in intensity but negatively impacts much of my life and activities? Are there things my doctor should consider or suggest or in communicating? — P.P.C.
ANSWER: Acute pain is usually due to an injury or infection, and we expect healing to occur relatively quickly. Chronic pain is expected for at least six months. In some, acute pain is not treated adequately at the time of injury, and the brain and body learn to be in pain chronically.
The reason for pain is obvious in some cases, but in others, it is not possible to identify the exact cause. Most times, pain is due to damaged nerves (neuropathic pain); injury or degeneration in the musculoskeletal system (osteoarthritis and many kinds of back pain); inflammatory pain (due to infection or inflammatory diseases like rheumatoid arthritis); and compressive pain (such as kidney stones or cancer).
Chronic pain affects many parts of life and an experienced doctor will ask about the effect of pain on your social life, mood (depression is very common), relationships, sleep, exercise and occupation. People with more severe problems will have limitations in daily living.
Many with chronic pain have almost given up communicating the scope of the problems they have, as they don’t like “complaining” all the time, or they feel loved ones are tired of hearing about it. However, getting a thorough history of the effect of all dimensions of pain is important. Questionnaires like the Brief Pain Inventory address more areas of function than a typical 1-10 pain scale, and may be useful to monitor treatment. Experts in pain management are more likely to have the knowledge and experience to communicate about pain effectively, truly effective treatment for chronic pain requires understanding it.
There can be pain without suffering. Suffering is the emotional component brought on by fear: “How bad am I going to hurt today? Will I ever be able to work again? All of my relationships are suffering.” Learning to live a function-centered life is key for chronic pain. It isn’t easy and requires a multidisciplinary approach.
The time of prescribing pain medications, especially opiates, without a plan for long-term pain management, should be over.
(Roach is a columnist for the North American Press Syndicate. Write to him at 628 Virginia Drive, Orlando, FL 32803.)