Treating chronic pain takes lots of communication



May 13, 2019 - 10:36 AM

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 so much of my life and my activities? Are there things my doctor should consider or suggest in my treatment or in communicating with me? — 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 to go on for at least six months. In some people, 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 perfectly obvious in some cases, but in others, it is not possible to identify the exact cause of pain. 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 your life, as you correctly note, 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 their activities of daily living. 

Many people 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 their loved ones are tired of hearing about it. However, getting a thorough history of the effect of all these dimensions of pain is important for your doctor. Questionnaires like the Brief Pain Inventory address more areas of function than a typical 1-10 pain scale, and may be useful to monitor response to treatment. Experts in pain management are more likely to have the knowledge and experience to communicate about pain effectively, and 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 in the treatment of chronic pain. It isn’t easy and requires a multidisciplinary approach.

The time of prescribing pain medications, especially opiates, without a comprehensive plan for long-term pain management, should be over.