If you had to guess the number one challenge faced by pain management physicians as they seek to treat their patients, what would you say? Would it be figuring out the right combination of medications? How about coming up with lifestyle changes that could help? Both are good guesses, but the number one challenge of treating chronic pain is something completely different. It is knowing how the pain feels.
Every doctor who treats a person suffering with a bad head cold knows what it feels like. He understands what the patient means as she describes her symptoms. He knows what a headache and congestion feel like. He also knows what has helped him find relief in the past.
Unless that same doctor has experienced chronic pain, he likely doesn't know what it feels like. He may not even fully understand the patient's description. This can be simultaneously frustrating and unproductive for both of them.
Pain clinics tend to operate on standard definitions. For instance, the WHO's standard ICD medical billing codes classify chronic pain as any type of pain that continues or recurs for at least 3 to 6 months.
The WHO's definition defines chronic pain based exclusively on the length of time it is experienced. Yet it doesn't speak to the severity of the pain, what it feels like to the patient, or any other factor that pain management doctors would need to know to treat it.
The reality of the matter is that a definition alone is not enough. So where do we go from there? Well, the WHO also classifies chronic pain under two different types:
The two classifications help clinicians understand cause or the lack thereof, but they still don't do anything to help a doctor know what it feels like. And unfortunately, patient explanations do not always do their experiences justice.
A person suffering from chronic pain may use any number of adjectives to describe it. A person's pain could be referred to as burning, shooting, or piercing. The patient may complain of a dull, aching pain or pain that gnaws at him.
The words are descriptive enough in the sense that a pain management doctor has probably experienced similar types of pain herself. She has had headaches, so she is familiar with the dull aching they can cause. She broke her arm as a teen, so she is familiar with what a sharp, shooting pain feels like.
Patient descriptions are good, but some are inadequate. There is something about chronic pain that makes it different. It could be the fact that chronic pain takes a mental and emotional toll severe enough to actually change the way the patient feels it.
Not only that, but mental and emotional anguish can lead to additional aches and pains that are not even part of the original condition. Trying to separate the different pains and their causes only complicates matters.
Pain clinics and the specialists who staff them do admirable work helping patients manage pain. But without personal experience, their biggest challenge of treating chronic pain is truly understanding how it feels. When a pain management doctor has no personal experience, their empathy has to be enough.