We all experience pain from time to time. Nearly all of us will even experience chronic pain at least once or twice. Patients and their general practitioners can usually work together to manage it just fine. So how do you know when this is not enough? How do you know it's time to visit a pain clinic?
Pain is a subjective thing. We cannot say you should visit a pain clinic if you've been experiencing pain for a certain amount of time. Yet despite not being able to provide a black-and-white answer, we can give you a few things to consider. Below are three signs it might be time to visit a pain clinic.
As you read, remember that KindlyMD is the largest QMP specialty group in Utah. Not only can our pain management physicians help you manage your pain, but we can also help you get a Medical Card if you qualify.
We genuinely appreciate the splendid work GPs do. GPs are internists, and internal medicine is one of the toughest specialties of all. GPs must be prepared to deal with just about anything. The downside is that they do not always have the resources and knowledge to effectively treat chronic pain. Therein lies the first sign that it might be time to visit a pain clinic.
Perhaps your GP has run out of options. The two of you have worked together on every pain relief strategy your doctor could think of. But despite all you've done, you haven't found sufficient relief. Your GP doesn't know what else to do for you. The good news is that a pain management physician probably does.
Another way to know that it might be time to visit a pain clinic is that your only options to date have been prescription medications. Unfortunately, traditional Western medicine relies far too heavily on a pharmacological approach to pain management. It is not always a bad approach, but it shouldn't be the only option. Some people just don't respond well to prescription medications.
If you have only been offered the pharmacological approach in the past, we want you to know that there are other options. One of them is plant-based medicine, which we promote here at KindlyMD. We understand that prescription medications are sometimes the best choice, and perhaps the only choice, for treating certain conditions. For example, some people with diabetes need daily injections of insulin to survive. Plant-based medicine, as diverse and effective as it is, cannot replace insulin.
But we also know that plant-based medicines can be remarkably effective for chronic pain patients. We believe pain clinics should give patients the choice.
The third sign it might be time to visit a pain clinic: you are concerned about the prescription medications you are currently taking. If this is the case, know that you are not alone. The more we learn about prescription painkillers, the more consumers are nervous about them.
It has been our experience that some chronic pain patients eventually reach a point of being willing to try anything. At least in some cases, they experience genuine anxiety about taking prescription medications for long periods of time. They are looking for plant-based alternatives as a possible way to cut back on prescription meds. We support that whenever appropriate.
Hopefully, the information we have provided in this post gives you a framework for deciding whether you should visit a pain clinic. Always remember that pain clinics are staffed by medical professionals whose specialty is pain. They are the most qualified to help you.
Utah residents diagnosed with certain qualifying conditions are eligible to apply for Medical Cards that give them access to certain types of herbal medicines. Given that KindlyMD operates a number of pain clinics here in Utah, we can also help patients apply for their cards. One of the tools we rely on to get the process started is a short quiz designed to quickly determine Medical Card eligibility
While the quiz is only a preliminary determination, the patient completes the quiz and submits it electronically. We can determine, from the answers given, whether a patient is likely to qualify. If so, the patient can then make an appointment to see one of our qualified medical providers (QMPs).
For KindlyMD QMPs to make a Medical Card recommendation, we need to verify two things. Our preliminary quiz helps us here by giving us some basic information. A patient's answers can give us a sense of their overall health and any health problems.
Here is what we need to verify:
To verify these two things, our quiz asks some basic questions. One of the questions relates to the condition for which you are seeking treatment. Chronic pain is one of the options you can choose. But we also ask:
The answers you provide tell us a great deal. We can learn a lot more by sitting down and talking things over in-person, but the quiz is a very useful preliminary screening tool. It helps both KindlyMD and its patients get a better idea of whether a Medical Card is worth investigating further.
Patients interested in visiting our QMPs to obtain their Medical Cards can complete our quiz online. It only takes a minute or so. If you are concerned about submitting information online, know that KindlyMD is HIPAA compliant. You might even notice a small seal at the bottom of the quiz designating as much.
HIPAA stands for the Health Insurance Portability and Accountability Act. In a nutshell, HIPAA is a 1996 federal law that requires healthcare providers to protect their patients’ sensitive medical information.
We take every precaution possible to protect patient data. We comply with all state and federal mandates relating to collecting and storing information online. But even if the legal mandates weren't there, we would still do our best to protect our patients. Your safety and security are important to us.
We assume you have visited the KindlyMD website because you are looking to visit a pain management doctor. If that's the case, we encourage you to take our Utah Medical Card eligibility quiz today. It may be that getting a Medical Card isn't your best option. But perhaps it is. There's no way to know without first visiting with a QMP. Our quiz is the starting point.
Believe it or not, taking the brief quiz accomplishes a lot. It gives us vital information we need to determine whether we can help you get your card.
Are you a chronic pain patient who often feels frustrated by the arbitrary pain scale doctors use to measure your discomfort? If so, you are in good company. Doctors feel the same frustrations from time to time. The unfortunate truth is that there is no scientific way to accurately measure pain. Still, a pain scale that may seem arbitrary to patients does mean something to doctors.
If you have no idea what we are referring to, pain management doctors regularly ask their patients to rate their level of pain on a scale of 1 to 10. We even have a graphic image featuring six emoticons – complete with facial expressions – to help patients make sense of the pain scale.
In a recent post published by Psychology Today, chronic pain patient and contributor Jen Sarché, MPH discussed both the pain scale and its accompanying graphic in terms that weren't very favorable. The truth be told, it's hard to argue with her assessment.
Sarché laid bare a fundamental truth every chronic pain patient knows – pain is a very personal thing. No two people experience it the same way. This is what makes the pain scale so frustrating to patients. Trying to rate their pain on a numerical scale is exceedingly difficult in light of the fact that they have no baseline.
Not only that, but the pain experience can also change on a daily basis. Things are made even worse when patients have to deal with multiple conditions that contribute to different kinds of pain. It all becomes an overwhelming mishmash of pain and the emotions that come with it.
We pain management doctors have great empathy for our patients. Our greatest desire is to offer some measure of relief. In order to do that, we need to have some idea of how a patient feels – both physically and mentally/emotionally. That's why we rely so heavily on the pain scale and its numeric rating system.
We don't hold to any fantasies that the pain scale is a scientifically accurate measurement of physical pain. But it does help us interpret where a patient is at any given time. For example, if you were to rate your current level of pain at 10, that tells your doctor that you cannot imagine things getting any worse. They know that you have reached your limit and you are looking for literally anything that will help.
It doesn't so much matter if your pain isn't really that intense (provided there were a scientific way to actually measure it). All that matters is your perception. You feel it is at 10 so that's what it is. Now your doctor knows how to respond.
If it helps you feel better about the pain scale, think of it as a communication tool rather than a diagnostic tool. You already know that the pain scale isn't in the same league as an MRI or CT scan. No doctor can look at the results of your pain rating and figure out what's causing you to feel the way you do. Instead, the pain scale is a way for you to communicate your current level of discomfort in a comprehensible way.
Chronic pain patients often find themselves frustrated when asked to rate their pain on a 10-point scaled. That is understandable. We pain doctors get it. But the pain scale is designed to help us understand how you feel so we can respond accordingly. Despite your frustrations with the scale, humor us. It helps us help you.
It goes without saying that pain management is not an exact science. People have different pain experiences. They have different levels of tolerance for pain. Patients also react to pain treatments differently. For pain clinics, the goal is to find what works best for each patient. Unfortunately, a new study shows that antidepressants may not be a reliable option.
Antidepressants are sometimes prescribed in lieu of prescription painkillers, physical interventions (like physical therapy, for example), and invasive procedures. But it would now appear as though antidepressants do not help much, if at all.
A study recently published in the BMJ not only suggests antidepressants are not appropriate for pain management, but it also goes on to explain why that might be. It's a fascinating study that deserves attention from pain management physicians and the clinics that employ them.
As we have mentioned in other blog posts, pain is generally a response to some other condition. It has been described by some pain management doctors as an experience rather than a symptom. Pain signals are sent to the brain for interpretation. A person's perception of those signals constitutes their pain experience.
In many chronic pain cases, doctors are content to prescribe medications designed to either block pain signals or at least take the edge off. These prescription painkillers vary in their efficacy and potency. Some are considered pretty risky because of a high propensity for addiction.
When medications are preferred but painkillers are to be avoided, doctors may prescribe antidepressants instead. This is considered an off-label practice. In other words, doctors are prescribing medications for purposes other than originally intended.
Antidepressants were introduced as an alternative for managing chronic pain based on their effects on brain signals. Drugs like amitriptyline and sertraline alter some of the brain chemicals known to contribute to the pain experience. As the thinking goes, alter these chemicals in the right way and it is possible to either block pain signals or reduce their intensity.
Unfortunately, the previously mentioned study found otherwise. Researchers from Australia conducted systematic reviews of 26 previous studies involving 156 trials with a combined 25,000 patients. The study considered 8 different classes of antidepressants being used to treat nearly two-dozen pain conditions.
To make a long story short, so to speak, in nearly every instance in which antidepressants seemed to help alleviate pain, they did no better than placebo. Researchers were left to conclude that what chronic pain patients believe about their pain has a greater influence on the pain experience than antidepressant medications.
The one bright spot is the use of SNRIs to treat neuropathic pain, fibromyalgia, and a couple of other specific types of pain. The medications proved effective 26% of the time for those particular conditions. But other than that, the researchers didn't turn up very much evidence in support of prescribing antidepressants for chronic pian management.
On one hand, it is a relief to know that patients are not imagining things when they report antidepressants aren't helping their pain. On the other hand, it's disappointing to learn that a long trusted therapy probably isn't helping. Underscoring the whole discussion is the reality that patients still need options. They need as many options as possible.
It's back to the drawing board for pain management physicians who tend to rely on antidepressants rather than prescription painkillers. Hopefully, future research will give us access to more tools. The more choices we can offer our patients, the more effective we can be as pain management physicians trying to bring much needed relief.
The emergence of pain management, as a specialty, has been a godsend in recent years to patients who haven't been able to find relief by working with their GPs. As with any other medical specialty, pain management works best when doctors and patients are able to establish a solid relationship built on trust and transparency. The relationship between pain doctor and patient is a sacred one.
It is not uncommon for chronic pain patients to ask for a referral to a pain management clinic after finding no relief in the GPs office. This isn't a knock on GPs, by the way. They have enough to deal with on daily basis. They cannot be expected to be experts in everything. As for pain management doctors, pain medicine is their specialty.
From the patient's perspective, maximizing pain medicine's benefits is all about making the most of that relationship with the pain doctor. Here are our suggestions for doing just that:
Pain is a very subjective and personal thing. We pain management doctors cannot run any diagnostic tests to figure out how patients are feeling. We rely almost exclusively on the conversations we have in the office. That leads us to the very first tip: tell us everything.
We are relying on you to give us every detail related to your condition. Tell us how you feel in the moment. Tell us what triggers pain, what you do to help alleviate it, and anything else that could possibly help us better understand what you are feeling.
Not only do we want you to tell us everything, but we also want you to ask us any questions that are on your mind. Your questions serve two purposes. First, they give you the opportunity to better understand your condition and why you feel the way you do. Second, they help us better understand where you are coming from.
Questions lay the groundwork for good conversations. So ask away. We will do our best to give you straightforward answers. If you ask a question for which we don't have an answer, we will make every effort to find the answer before your next visit.
Patient records are tremendous help to us. If we had our way, every chronic pain patient would keep meticulous daily records relating to everything about their health and pain experiences. Records provide us with invaluable data that helps us make good recommendations. You can help us be better at what we do by writing things down. Just be sure to bring your records to each visit.
Last but not least is heeding our recommendations. Know that we understand you get frustrated when you feel like your pain doctor is relying on the 'let's try it and see' approach. But the very personal nature of pain sometimes leaves us with no other choice.
We offer recommendations based on our conversations with you. We combine our observations with what we know about pain medicine to steer you in what we believe is the right direction. But we don't always get it right. Still, we need you to heed our recommendations and then get back to us with the results. That is how we work together to find the relief you are hoping for.
We take our relationships with patients seriously. We hope you take the relationship with your pain doctor just a seriously. When patient and doctor build a relationship on mutual trust and transparency, good things happen. That is ultimately the end goal.
One of the hallmarks of a successful pain clinic is a willingness to develop individualized treatment plans for each patient. Individualizing treatment offers multiple benefits, not the least of which is the ability to look into a long list of treatments rather than sticking with just one or two.
How many treatments are there? Too many to really do justice to all of them in a single post. However, we can divide all the treatments into a number of categories for better understanding. As you read through these categories, keep in mind that KindlyMD is fully on board with the idea of individualized treatment.
Western medicine is heavily dependent on the concept of pharmacology. As such, we would expect drug therapies to be the primary category of pain treatment options. That they are. Drug therapies can take many forms:
Each type of medication targets pain in a different way. Pain management doctors work with their patients to figure out not only which type of medication to utilize, but how they expect it to offer relief.
Pain medicine has really begun to embrace injection therapies over the last few years. These treatments rely on targeted injections to help provide long-term relief from certain types of pain. Some of the injections make use of steroids and anesthetics. Others might utilize something similar to Botox. Injection therapies tend to be a good option for musculoskeletal pain, certain types of headaches, and even fibromyalgia.
The next category, surgical therapies, tends to set off alarm bells for a lot of chronic pain patients. The thing to understand is that not all the surgical procedures are considered major procedures. Spinal cord stimulation is a good example. It involves a minor surgical procedure that implants a small device underneath the skin.
Just about everything else not covered in the first three categories is considered an alternative therapy. Perhaps the most recognized of these alternatives is physical therapy. Believe it or not, physical therapy can go a long way toward alleviating some types of pain.
Here are some of the other therapies in this category:
There are more than a dozen other therapies in the alternative category. The most important thing to remember with every single pain management treatment is that results can vary.
The whole point of developing individualized treatment plans is to ultimately discover the therapy or therapies that work best for each patient. A good pain management doctor will never unequivocally say that one particular treatment is always best. That's not true of every patient.
An individualized treatment plan helps us figure out what is most likely to offer you maximum relief. Sometimes we hit on it quickly, other times we need to try a few things first. Nonetheless, the benefits of individualized treatment are undeniable. Pain medicine continues to prove it every day.
Pain clinics around the country see plenty of patients complaining of work-related back and neck pain. KindlyMD pain management doctors hear the same complaints. Neck and back pain among office workers who spend their days sitting in chairs and working on computers is fairly common.
Work issues aside, back pain is actually the most often heard complaint in the doctor's office. The combination of a sedentary lifestyle and daily activities that put stress on the back make it nearly impossible to avoid experiencing back pain at some point.
Getting back to work-related back and neck pain, there are ways to deal with it other than taking prescription or OTC pain relievers. Here are just a few suggestions:
Ergonomics is the science of adjusting one's environment for the purposes of reducing unnecessary stress on the body. In an office setting, ergonomics addresses things like seating, posture, computer position, etc.
Perhaps your current work environment is not especially ergonomic. Take some time to research how you might change that. Just repositioning your computer screen or changing the way you sit in your chair could make an enormous difference.
Some people find pain relief simply by changing their positions as often as possible. Perhaps there are certain tasks you can do while standing. Reading your email is one possibility. If you can do it standing up, give it a try. Frequently switching from a sitting to a standing position requires your body to use different muscles. Over several weeks, you might actually feel a lot better.
If alternating between standing and sitting is not possible, you can at least change your position in the chair. You can shift your weight to one side and then the other. You can sit as far forward as possible and then alternate by reclining slightly. There are plenty of possibilities.
Another helpful tip is to take regular breaks. Every hour or so, stand up and stretch. Take a walk during your morning and afternoon breaks. The idea is to move as much as possible whenever your work affords the opportunity to do so.
Taking regular breaks will also alleviate the stress on your eyes. Believe it or not, doing so could reduce tension in your neck and thereby reduce your neck pain. Additional pain relief could come from holding your head straight up instead of staring at a screen. So on your breaks, leave your phone at your desk.
You knew it was coming and here it is – a recommendation to get regular exercise. Stretching exercises throughout the workday can keep your muscles relaxed and your joints nimble. Away from the office though, regular exercise can actually strengthen those muscles and joints.
Stronger muscles are better able to support the joints. And when that happens, you are less likely to experience back and neck pain. As an added benefit, regular exercise will help you maintain a healthy weight and reduce the risks of developing a long list of health conditions.
None of this is meant to suggest that all work-related back and neck pain is minor and can be alleviated through ergonomics and exercise. There are legitimate cases of severe pain requiring professional pain management.
If you are experiencing severe back or neck pain, we urge you to see your doctor or make an appointment at our pain clinic. KindlyMD pain management doctors will do everything possible to help you. If your pain is minor, try the tips you just read about.
Pain is a curious thing. It is more of an experience than anything else, an experience that takes place in the brain as a result of signals received from other parts of the body. The most curious thing about managing chronic pain is that it seems to be related to a person's mindset. At least that's the thinking of a pain management doctor recently interviewed by Runner's World.
Dr. Abdul-Ghaaliq Lalkhen, M.D. is a pain expert, author, and member of England's Royal College of Anesthetists. His extensive experience in pain management has helped him understand the relationship between pain and a person's mindset.
Pain management doctors the world over recognize pain as a warning sign. It can be a warning sign of physical danger, mental danger, emotional danger, or any combination thereof. There doesn't necessarily have to be a physical manifestation of the pain, either. In fact, pain medicine doctors have a term for pain that cannot be connected to a known physical malady. They call it non-specific pain.
Given that pain is a warning sign, how the brain interprets that warning sign can influence the pain experience itself. Dr. Lalkhen offers a simplified explanation in the example of a car alarm. A car alarm going off in the middle of the night is a warning that something is going on with the car itself. But we all know from personal experience that people react to car alarms differently.
Some people immediately panic and assume the worst. They rush to call the police before investigating the issue. On the other end of the spectrum are people who have learned to ignore car alarms no matter when they are heard or how loud they are.
Just as people react differently to car alarms, they also react differently to pain signals. This influences the pain experience. People who react one way might feel more intense pain while those who react another way are not bothered by it as much.
A person's mindset can affect the pain experience in terms of what we call pain tolerance. A certain mindset can mean a higher tolerance for pain. But there is another factor in play: stress. Pain at any level induces some amount of stress in the person who experiences it. How that person reacts to the stress further impacts the pain experience.
This particular issue is one that chronic pain sufferers are intimately familiar with. A typical chronic pain patient has good and bad days. Helping them get through the bad days is one of the main things we focus on at pain clinics. That aside, pain-related stress can be significantly greater on the bad days.
Research has shown that stress can increase a person's perception of pain. So under certain conditions, pain and stress can work together to create a cycle that only worsens the experience of pain over time. Pain causes stress; the stress increases pain perception; and a greater pain perception creates more stress. It becomes a vicious cycle that can be difficult to break.
It would appear as though a person's mindset can affect the pain experience. Still, do not misunderstand the point here. None of this is to say that chronic pain is all in your head. It's not. Pain is a very real experience that can be caused by an endless number of things. The only point being made here is that working on changing one's mindset could help some patients manage chronic pain more effectively.
At KindlyMD, our pain clinicians see a wide range of patients, including some who live with a substance use disorder.
We recognize that substance use disorders and addictions can be treated successfully with patient-centered, “whole person” care.
Pain clinicians like ours must give special consideration to someone dealing with both chronic pain and a substance addiction.
“Providing pain control for the 5% to 17% of the U.S. population with a substance abuse disorder of some type presents primary care physicians with unique challenges. When these individuals experience pain, they are less likely to receive adequate pain management than individuals in the general population,” wrote the authors of a 2002 study called “Successful Pain Management for the Recovering Addicted Patient.”
In cases like these, it’s crucial to provide effective pain relief options without contributing to the underlying addiction. Fortunately, our pain specialists and behavioral health clinicians have the experience and expertise to guide patients who struggle with addiction.
Here are some of the ways KindlyMD helps its patients manage pain and break the cycle of drug dependence.
During a patient’s first visit to a KindlyMD clinic, we’ll spend time getting to know that person and their needs. We’ll discuss the patient’s medical history, the medication(s) they use, and the reasons the patient requested our services.
This conversation helps the patient’s care team achieve one of its first goals: “to meet you where you are.” In other words, we listen to each patient’s needs and provide appropriate treatment options for his or her unique circumstances.
We want our patients to feel heard, understood, and cared for in all their experiences with KindlyMD.
"Medication management” means overseeing a patient’s prescribed medications, ensuring they’re used correctly, and achieving the desired therapeutic results. This process requires special considerations for patients struggling with pain and an addiction or substance use disorder.
Thankfully, our prescribers have the knowledge and experience to develop effective plans for maximizing pain relief while minimizing addiction potential.
One strategy, called “tapering,” involves gradually reducing the doses of a potentially-addictive medicine. Tapering allows the patient to begin using safer alternatives to dangerous prescriptions without suffering from withdrawals.
Living with chronic pain and a substance use disorder affects a person physically and emotionally. Many pain clinics address their patients’ physical concerns with drugs and other therapies but fail to address the emotional aspect.
“You really need both a prescriber and a behavioral health clinician embedded at the point of care to accomplish better outcomes for patients,” explained KindlyMD founder Tim Pickett, PA-C during a recent presentation on dangerous prescription painkillers.
As mentioned earlier, we believe the ideal approach to healthcare means treating the “whole person,” not just symptoms like pain. This is why we chose to integrate behavioral health clinicians into the services we offer.
Our behavioral health clinicians listen closely to our patients’ healthcare goals and develop strategies to help them succeed.
Modern medicine provides us with a wide variety of treatments for managing chronic pain. This variety allows pain management clinics like ours to develop a personalized treatment plan for each of our patients.
Many patients find natural, plant-based alternatives to traditional pain medications very effective in treating pain. Herbal medicine can also be useful in weaning a patient off potentially dangerous medications and other substances.
If you’re living with chronic pain but worry about the potential of becoming addicted to painkillers, we’re here to help. One of our goals is to help our patients eliminate medications that no longer work or potentially cause harm.
Our experience has taught us that “deprescribing,” under medical supervision, often leads patients to a happier, more fulfilling lifestyle. Let us help you achieve that same goal. Call 385-388-8220 or click here to book an appointment with KindlyMD.
