How to Talk to Your Doctor About Your Pain
You would think that doctors, of all people, should be sensitive to pain. Unfortunately, that’s often not the case.
For one thing, doctors are human beings. The truth is, it’s really difficult for anyone - even doctors - to understand something they haven’t experiencecd themselves. We’re all that way. Someone who hasn’t been abused as a child can’t really understand the impact that experience has on the rest your life. Or, if you’ve never lost a child, you can’t really know the depth of emotional pain a parent feels in that situation. We may care and sincerely try to imagine what that person must be going through, but the fact is, we can’t fully understand it if we haven’t experienced it.
This situation is not helped by medical schools, which may not spend as much time as we would like teaching future doctors how to treat pain. On top of that, some doctors may be fearful of losing their licenses if they prescribe too many opioid (or narcotic) medicaitons or if one of their patients abuses the medication. So, when you put all of that together, it’s not surprising that sometimes doctors would rather just ignore pain than try to treat it.
Preparing to Talk to Your Doctor
So, how do you convince your doctor first that you are in pain, and second how bad your pain is? The first thing is to be prepared for your appointment. Don’t just go in there and "wing it." Most of us get at least a little nervous in the doctor’s office and we’re apt to forget something important. Think out ahead of time what you want to tell and ask the doctor and write it down. Ideally, take two copies with you - one for you and one for the doctor to follow along and then put in your file.
Pain is subjective. It’s virtually impossible for one person to know exactly what another person’s pain feels like. So, particularly when your talking with your doctor, it’s important to describe your pain in a way that will give him or her the best picture possible of what you’re experiencing.
When it comes to pain, there are five questions you need to be prepared to answer for your doctor:
1. Where are you having pain? Be specific about exactly where the pain is. Don’t just say, "my back hurts." Say, "my back hurts just above my waist, then the pain seems to travel into my hip and down the back of my leg." If possible, point to the exact spot that is painful. If you have something like fibromyalgia where the pain may move around, tell him the different areas that are sometimes painful and which areas most often hurt.
2. When do you experience the pain? Saying you’re always in pain doesn’t really help much. You might say something like, "I always have a certain amount of aching pain in my whole body, but it’s worse when I first get up in the morning. Then if I stand for more than 10 minutes, I have severe low back pain." Be sure to tell the doctor what movements or activities make the pain worse.
3. What kind of pain are you having? Do your best to describe what your pain feels like. Is it stabbing, aching, burning, shooting? The type of pain you have can be more important than you realize. Different types of pain may be indicative of different problems.
4. How bad is the pain? Usually doctors will ask you to rate your pain on a scale of 1 to 10, with 10 being the worst pain you can imagine. Now what I’m going to say next, I cannot stress enough. If your doctor asks you to rate your pain on a scale of 1 to 10, DO NOT under any circumstances say 15 or 100 While you may be trying to express that your pain is really bad, what your doctor hears is that you are prone to exaggerate and your pain is probably not actually all that bad. I can assure you that overstating your pain on the pain scale will have the opposite effect of what you’re trying to accomplish.
Be as honest and realistic as you can. Remember that a 10 is the worst pain you can imagine. Unless you’re screaming and writhing on the floor, your pain is probably not a 10. If you’re able to sit in a chair and talk fairly normally, your pain is definitely not a 10. Many women equate a 10 with natural childbirth. That is probably close. Although I had twins naturally, and I would give it a 9 because I still feel like there could be an even worse pain. But I wouldn’t argue that point. The important thing is to take the pain scale seriously and rate your pain accordingly.
For more information on how to rate your pain on the pain scale, read: _Using the Pain Scale Effectively _
5. How does your pain affect your life? Although this is a question your doctor may not ask you, it is something you need to be sure to tell him. This may be one of the best and most accurate assessments of your pain you can give. And if you are or think you might ever be applying for disability, the answer to this question is critical. It’s usually best to describe what you could do before the pain began and what you can do now. For example, "I used to be able to work at my desk for four hour stretches, but now I can’t sit for more than 15 minutes at a time." - or - "I used to be able to vacuum my whole house at one time. Now after vacuuming one room, the pain is so bad, I have to stop."
I learned the importance of making these types of comparisons firsthand. After several years of taking the same medication for my fibromyalgia pain, my doctor was suddenly hesitant about continuing to prescribe it. I simply told her that with the medication, I was able to work from home enough to support myself; without it, I would not be able to work at all. She gave me the prescription and has not questioned it since.
One thing that may be helpful to you and your doctor is keeping a pain diary for at least a couple of weeks. Basically, you just write down various details about your pain each day. A pain diary can help your doctor pinpoint the cause of your pain or track how a new medication is working. It may also help you identify some lifestyle changes that could help lessen your pain levels. It’s worth trying.
For more information on keeping a pain diary and a downloadable pain log, see: _Keeping a Pain Diary _
The Issue of Opioids
One final thing and important thing that I’d like to share with you is don’t start out by asking for pain medicaiton - particularly opioid medications. Doctors always have to be on the alert for drug abusers who are faking pain to get drugs. They have no way of knowing you are a responsible person who wouldn’t consider misusing your medications.
Asking for pain medicaiton, particularly asking for a specific drug like oxycodone, will send up red flags and you will be viewed with suspicion from then on.
Most doctors consider opioid medications the last resort for treating pain.
They will expect you to be open to trying other forms of treatment before they even consider opioids.
And you should know, a number of doctors refuse to prescribe any opioids at all, regardless the problem.
If your pain is bad enough to need opioids on a regular basis, you’ll probably have to go to a pain management specialist.
If Your Doctor Still Doesn’t Understand
If you’ve done everything possible on your part to explain your pain clearly and accurately and your doctor still doesn’t seem to understand or is still not willing to treat your pain adequately, all you can do is try to find another doctor. The fact is, you can’t force someone to understand or be compassionate. Unfortunately sometimes it takes a lot of trial and error to find the right doctor to treat your pain. But don’t give up because they are out there.
Karen is the co-founder of the National Fibromyalgia Association. She wrote for HealthCentral as a patient expert for Pain Management.