Being pain management doctors gives us the opportunity to get to know patients from all walks of life. One of the more interesting aspects of this particular medical specialty is observing how different people perceive and manage their pain. Some patients take a very philosophical approach that ultimately leads to a unique perspective.
Looked at another way, there are always those two or three patients whose philosophy on pain sets them apart from everyone else. They just have a unique way of looking at things. Their individual perspectives are neither better nor worse than anyone else's. They are just different enough to stand out.
As much as we pain management doctors like to believe we can make everyone feel better, that is not always the case. Medical science knows a lot about pain. But there is also a lot that remains unknown. There are times when our lack of knowledge prevents us from offering patients the relief they so desperately want.
Such is the case with Atlantic contributor Kieran Setiya, whose November 2022 piece details her own struggle with chronic pain. Setiya considers herself a philosopher by nature. So when her doctors eventually admitted there was little they could do to help her, she turned to philosophy to manage her daily life with pain.
It is interesting that Setiya describes her life, in part, as living with "the hum of pain as background noise." If you are not a long-term chronic pain patient, the concept may be foreign to you. But try to imagine something in your house that constantly makes a low-grade noise in the background. Maybe it's your refrigerator.
The hum of the refrigerator can constantly be heard if you are listening for it. Get distracted by daily life and you mostly forget about it. But after five or 10 minutes of distraction-free quiet, you suddenly notice the hum once again. Get up in the middle of the night for a glass of water and the refrigerator will sound louder than it ever has before.
Chronic pain can create a similar sensation. Chronic pain sufferers always know the pain is present, but it may be easier to ignore when one is busy doing what needs to be done to get through the day. Occasional flareups occur, but the worst of the pain is felt during the patient's downtime.
The lesson here is that perception plays a big role in how debilitating chronic pain is. This is not to say that those who find themselves debilitated are weaker than others who continue to function normally. It is simply to remind of the fact that patients perceive pain differently.
Some of us have fairly high pain thresholds. Others have low thresholds. It is all part of the unique nature of each individual human being. Regardless of any one person's perception of pain, philosophy may be able to do what medical therapies cannot.
Kieran Setiya discovered that philosophy could change her outlook on pain. She is long past trying to remember what being pain free was like. She also doesn't try to imagine a pain-free future. Instead, she takes the approach of living in the moment.
Our poor synopsis of Setiya's post doesn't do it justice. You should probably read it yourself. Whether or not you choose to, remember that our pain clinic is here to help you. Pay us a visit and we can offer you a solemn promise to do everything within our power to help you feel better.
Rheumatoid arthritis is an uncomfortable disease in its mildest form. More severe cases can be completely debilitating. With that in mind, we encourage rheumatoid arthritis patients to not wait to discuss pain with their doctors. If there are any changes in the level or type of pain a patient experiences, a discussion with the doctor is warranted.
The CDC estimates that about 58.5 million Americans have been diagnosed with some sort of arthritis. Among them, approximately 1.5 million suffer from rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease characterized by the patient's own immune system attacking joints.
Not waiting to talk with the doctor about your pain is important for a couple of reasons, the first being that immune response changes over time. Like everything else in your body, your immune system is constantly trying to adapt. As your circumstances change, the way your body responds is likely to change as well.
Pain management doctors try to home in on those changes to figure out what is going on. They can do a better job of helping you manage pain or your pain medication if you let them know about changes as soon as you notice them. Simply put, the sooner you and your doctor can address changes in how you feel, the greater the chances of effectively dealing with the resulting pain.
It is well understood by pain management physicians that lifestyle changes can help some patients with rheumatoid arthritis feel better, especially as winter sets in. This is yet another reason to speak to your doctor as soon as possible when your pain levels change.
A good example familiar to many rheumatoid arthritis patients is maintaining some level of activity. Physical activity helps to maintain muscle, tendon, and joint strength. In turn, stronger joints tend to feel less painful. But what if changes in your condition lead you to be less active?
Reduced activity is a common risk among rheumatoid arthritis patients. As pain increases, activity levels decrease. Some patients eventually become sedentary in order to avoid more pain. What they do not realize is that less activity is probably increasing their pain
Sticking to the same example of physical activity, waiting too long can make it harder for your doctor to help you manage increased pain. Let's say you notice more pain in one of your joints and it prompts you to make an appointment with your doctor right away. The two of you can come up with strategies to address the change before it begins seriously limiting your activity.
On the other hand, if you wait until you are already sedentary to speak with your doctor, it is going to be much harder to come up with a good pain management plan. It's certainly going to be more difficult to get back into a regular routine that includes more activity.
By itself, pain is not a disease or condition. It is a symptom of some other issue. At pain management clinics, we tend to think of rheumatoid arthritis pain as a signal of what the patient's immune system is doing. How a patient experiences the pain can tell us a lot about the current state of the disease.
It is better for your doctor to know about changes in those signals as soon as possible. So if you suffer from rheumatoid arthritis, whether you seek treatment from your GP or a pain management doctor, be sure to speak up about changes in your condition as soon as you observe them.
You have probably noticed that some people have a higher pain threshold than others. Likewise, you might find it hard to understand why some people seem to experience so much pain due to a condition that barely bothers you. It turns out that we all experience pain differently. Not only that, but past experiences can also influence current pain perception.
Pain isn't actually a biological function that can be measured the same way as blood pressure or heart rate. Rather, pain is a function of the brain. It is a mental reaction to some sort of stimuli the brain perceives as danger. It's a signal that there is something wrong.
The nature of pain is such that the brain can store data from a particular pain experience and then retrieve it later on. It can also store information on traumatic events. Both types of data, when recalled, can influence pain perception.
Explore your own memories and try to remember what it felt like to sit in the dentist's chair as he prepared to drill out your cavity-ridden tooth. You were probably afraid long before he started drilling. Now, do you remember the pain? If not, you probably still remember feeling very anxious and nervous.
Your brain stored some of that information away. As an adult, you may now feel the same anxiety and fear whenever you need to visit the dentist. And if this is the case, your anxiety and fear can magnify your sensation of pain. Unpleasant experiences from your childhood contribute to unpleasant feelings as an adult.
Past experiences tend to put an indelible mark on the memory whether we are conscious of it or not. Where pain is concerned, those stored memories are not only capable of influencing pain perception, but they are also capable of contributing to chronic pain conditions.
Trauma is another factor that can influence pain perception. We don't know all of the nuts and bolts behind it, but studies have shown that people who tend to experience more frequent and severe chronic pain are also more likely to have experienced some sort of trauma in the past.
For the purposes of this discussion, trauma is defined as an event that causes hyperarousal in the brain. A soldier on the battlefield finds himself in a fight or flight situation. Medical science would consider that hyperarousal.
The brain reacts a certain way when in a hyper-aroused state. And just like with memories of pain, it can store information about a hyperarousal event and then retrieve that information later on. This is the very mechanism behind post-traumatic stress disorder (PTSD).
In some people, pain perception is influenced when a pain event triggers the release of stored trauma information. Interestingly, a person doesn't even have to remember the past trauma to feel its effects. If the brain releases information from that past event, the perception of pain can be made more severe.
The point of all of this is simply to illustrate that pain management is not an exact science. It is quite complex. That's why we believe so strongly in individualized treatment plans. We do not subscribe to the idea that pain management is only a matter of finding the right prescription meds. There is a lot more to it than that.
If you are experiencing what you consider severe pain, you're not alone. Know that your pain probably has physical causes, but your perception of that pain could be influenced by past experiences and traumas. We will do our best to help you figure it out.
Pain management exists as a medical specialty based on a genuine desire to help people suffering from chronic pain feel better. But the consequences of pain are not just physical and emotional. They are financial as well. And sometimes, the wrong approach to pain management can ultimately cost more.
It is not wrong for pain clinics and the physicians they employ to look at pain management from a financial perspective. After all, patients struggling with the cost of healthcare services may experience a level of stress that only makes their pain worse. Minding treatment costs is just as important as coming up with effective strategies to help patients feel better.
The Tampa Business Journal recently published a fascinating post discussing the cost of pain management from the perspective of managing cancer pain with opioids. Author Alexis Meullner explained that physicians often prescribe drugs like morphine and oxycodone to address cancer pain. What they do not realize is that research shows that opioids, even at low doses, can help cancer spread faster by altering a patient's immune system.
Should this happen, the cost of treating that patient ultimately goes up. As the cancer spreads, more aggressive treatments are necessary. Those additional treatments only add to the cost.
That says nothing of the mental and emotional toll it takes on patients. No cancer patient wants to hear that their cancer has spread. The news can take such a heavy toll that additional stress and anxiety only make treatment harder. The result could be longer hospital stays, more intense symptoms, and so forth.
Treating cancer pain with opioids can contribute to medical costs by inadvertently exacerbating the patient's condition. But let us step away from cancer and talk about other conditions that cause chronic pain for years at a time. Fibromyalgia is a good example.
Fibromyalgia is a condition typified by chronic pain in multiple areas throughout the body. Patients often describe themselves as being in constant pain. Pain management doctors can offer patients immediate relief or take a more long-term approach to pain management.
In the short term, prescription medications can alleviate fibromyalgia pain quite a bit. But over the long term, those same medications can become quite expensive. What if the doctor takes a long-term approach from the onset?
The wrong approach to pain management is to never get beyond the drugs. It is to write prescriptions and never go any further. Prescription medications are a necessary part of the equation, but all they do is mask pain. Chronic pain patients need to get beyond masking.
One suggestion a pain management doctor might make to a fibromyalgia patient is that of getting regular exercise. There are days when exercising can be difficult. But in the long run, most patients respond very well to it. Regular exercise keeps the body active, mobile, and strong. That ultimately leads to less pain.
In some fibromyalgia patients, dietary changes can make an enormous difference. Medical science still doesn't know exactly why, but does it really matter from a pain management standpoint? No. If a patient's pain can be better managed through a specific diet, making the necessary changes will have long-term effects that go well beyond what prescription medications can do.
The more we learn about managing chronic pain, the more we discover that there are right and wrong approaches. Unfortunately, taking the wrong approach can exacerbate a patient's medical condition by adding to the financial cost. Keeping costs in check is a legitimate concern not to be ignored.
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.
Narcotic painkillers continue to be a mainstay within the surgical arena. Doctors are ready to prescribe drugs like Percocet and OxyContin when they believe post-surgical pain warrants it. But is there another way? Is there a more holistic way to approach surgical pain?
Allentown, PA TV station WFMZ recently ran a story featuring Mercy Medical Center surgeon Dr. Lauren Nigro, a story in which she suggested a movement within her own specialty to treat pain before, during, and after surgery in order to avoid narcotic painkillers.
By taking a holistic approach, doctors who treat surgical pain in this way hope to reduce the chances that a patient will suddenly be excessively uncomfortable following surgery. The thinking makes sense from a chronic pain management standpoint as well.
Dr. Nigro explained during the interview what a typical scenario looks like. Patients are prescribed acetaminophen they take for several days before their surgeries. During surgery, a nerve block that can remain active for several days is employed. Finally, non-opioid pain medications and non-steroid anti-inflammatory medications are prescribed following surgery.
This revolutionary approach more or less applies a pain management concept to surgical procedures rather than the more traditional approach of treating pain after the fact. Managing it all the way through reduces the highs and lows patients experience. The thinking is that they feel better as a result.
Treating surgical pain in this way may not be the norm, but it is well worth looking into and developing further. Based on our experience as pain management doctors, we know that how patients perceive pain influences how effectively that pain can be managed. So minimizing the differences between highs and lows makes a lot of sense.
Think of it in terms of mood swings. A doctor treating a patient for a mood disorder wants to minimize the swings so that the highs are never too high and the lows are never too low. Keeping the patient's mood on a more even keel is an important part of the treatment.
Managing surgical pain would seem to benefit from a similar principle. And if the approach works well for managing surgical pain, it might work for managing chronic pain as well.
Where this gets tricky is determining the best holistic strategy for chronic pain. It is one thing to manage surgical pain until the patient fully recovers. But chronic pain can persist for years. It's an entirely different animal. The important thing to note is that prescription drugs are not always the answer.
So many patients wind up at pain clinics because their primary care physicians haven't been able to come up with solutions other than writing prescriptions. This isn't a knock against GPs. They are doing what they are trained to do. Pain management doctors look at things a little bit differently. At least they should.
By the time a patient shows up at a pain clinic for the first time, prescription drugs have already been tried. They haven't worked.
In some cases, it is a matter of having not tried the right medications. But in other cases, effective pain management requires a different approach. For many patients, everything from behavioral changes to physical therapy and alternative treatments are more appropriate than yet another prescription.
It would appear as though managing pain through a more holistic approach can help surgical patients feel better. What if we applied a similar mindset in the chronic pain arena? A more holistic approach could make an enormous difference.
Have you heard of 'tech neck'? If not, we recently published a post about it. You might want to read it. At any rate, tech neck is the informal name of a condition caused by too much time spent using digital technology. But there is another technology-related condition that was discovered before tech neck: carpal tunnel syndrome.
Tech neck is largely the result of looking down at phone screens. Carpal tunnel syndrome manifests itself as pain in the wrists. It can be caused by any number of repetitive behaviors involving the wrists, lower arms, and elbows. But in the technology age, it is frequently associated with phone and computer use.
Carpal tunnel syndrome is one of the more common repetitive stress conditions pain management doctors deal with. It is frequently experienced by office workers whose jobs include things like coding and typing.
The condition is so named because it affects a small opening in the wrist known as the carpal tunnel. This is the tunnel through which the median nerve passes. It is formed by carpal bones on the bottom and sides and the carpal ligament on the top.
It turns out that the carpal tunnel in adults is only about an inch wide. Unfortunately, the bones and carpal ligament are very rigid. That means there isn't a lot of room for the tunnel to flex or expand when necessary. Therein lies the big issue with carpal tunnel syndrome.
Carpal tunnel syndrome occurs either when the tunnel itself narrows or surrounding tendons become inflamed. Both conditions put pressure on the median nerve where it passes through the tunnel, reducing blood supply and generating the symptoms associated with the syndrome.
Those symptoms include:
In most cases, symptoms begin gradually and are mild enough to not be associated with the syndrome. It is easy to mistakenly associate the pain and tingling with something else. But over time, symptoms become more pronounced and severe. They can persist for a fairly long time.
Minor cases of carpal tunnel syndrome that resolve quickly can be treated with anti-inflammatory medications and over-the-counter pain medications. But due to the very nature of carpal tunnel syndrome, minor cases with easy resolution are the exception to the rule.
Instead, pain management physicians need to take into account that carpal tunnel syndrome is the result of repetitive stress. They need to think about other treatments, which could include:
Unfortunately, the way we use technology increases the likelihood of experiencing carpal tunnel syndrome. But with the help of a good pain management physician, pain relief is possible. Just like tech neck, you don't have to grin and bear carpal tunnel pain.
Visiting the doctor with complaints of chronic pain almost always means walking out with a prescription in hand. While a prescription may be appropriate, there may be other way pain management options that may be more effective. In addition, medications themselves need to be managed properly.
One of the things we stress at KindlyMD is med management. Our providers have treated chronic pain long enough to know that med management and pain management are intrinsically related. They go hand-in-hand.
Med management involves a number of key factors:
Experienced pain management doctors know that their patients feel and respond to pain differently as time goes on. They know that effectively managing pain is not a matter of writing a single prescription the patient can continually refill time and again.
We view med management's relationship to pain management from the perspective of giving patients control. As a patient, you are no longer content to let your healthcare provider exclusively dictate how you're going to manage your pain. You want a say; you want to contribute.
Where med management is concerned, your input is vital. Only you know how your body reacts to the meds you take. Only you truly understand the side effects of those meds. Your pain management physician can know and understand your symptoms, but they cannot actually feel what you feel because they are not you.
As for pain management physicians, their biggest role is to guide and advise. They function as trained assistants to help patients find the best path for their own individual journeys. Sometimes that might involve prescriptions. It might involve med cards and other alternatives as well. But ultimately, the patient is always in control.
Med management can be approached from the Western medicine mindset. But it can also be approached holistically. We prefer the latter here at KindlyMD. A holistic approach to any treatment seeks to care for the body, mind, and spirit collectively. That's a better way to go for long-term pain management.
Holistic med management is designed to combine the best of traditional and holistic approaches. The ultimate goal is to reduce dependence on prescription meds as much as possible. In their place are plant-based medicines and other therapies that work hand-in-hand to help a patient adequately manage pain for a fuller and better life.
The holistic approach to med management:
Med management is just one aspect of pain management. You could probably argue that it's the most important aspect inasmuch as we rely so heavily on medications.
We feel that by helping patients manage their meds better, we are also helping them manage their pain without having to rely so heavily on traditional medications and therapies. We have nothing against traditional medicine in and of itself. However, we do believe that a more natural, plant-based approach with a holistic foundation is a better way.
You may be quick to think of things like arthritis and cancer when someone mentions chronic pain. Both conditions are worthy of serious attention from pain management doctors. But less serious causes of pain deserve attention, too. For example, consider the condition known as “tech neck.”
Tech neck isn't yet an official term in medical dictionaries, but it is a real thing. Tech neck is a condition affecting the muscles, tendons, and ligaments in the neck and shoulders. It is characterized by neck strain and general pain in the head, neck, and shoulders.
As you probably guessed, tech neck is caused by using too much technology, too often. It is the direct result of constantly looking downward at screens. Between cell phones and computers, far too many of us find ourselves looking downward for 8 to 10 hours per day, if not longer.
We have seen an up-tick in tech neck since the COVID pandemic. The same goes for other tech related maladies, like carpal tunnel syndrome. The good news is that pain management doctors are specialists capable of helping patients find relief.
If you are suffering from tech neck or any other technology related, pain-inducing malady, take heart in the fact that relief is possible. Here are three tips that could help you get the ball rolling toward feeling better:
We decided to put the most difficult tip first: reduce your technology time. The science behind this tip is pretty straightforward. If you avoid doing things that cause pain, your pain will likely decrease over time.
Unfortunately, many of us are tethered to our technology for work purposes. Still, look for ways you can do your work that require spending less time looking down. Raise your computer screen. Stand if you can. When you use your phone, lift it up in front of you.
Outside of work, make a concerted effort to use your phone less. Maybe commit to turning it off after dinner and leaving it off for the rest of the evening. Perhaps it's appropriate to set rules for the entire family. Whatever it takes to reduce your screen time is worth it in terms of pain reduction.
Your pain management physician can recommend some simple exercises for loosening tense muscles and strengthening the neck. They are easy enough that just about anyone can do them. Moreover, you can do them in the comfort of your own home or office.
Neck exercises are an important aspect in keeping your neck muscles in good shape. When you work to strengthen them, you are also strengthening tendons and ligaments. It all adds up to more support and less pain.
The third thing you can do to combat tech neck is pay a visit to your healthcare provider. Whether that's a doctor, a physician assistant, or a nurse practitioner, your provider can help you devise strategies for reducing pain.
As far as pain meds are concerned, we strongly recommend a plant-based approach. Prescription drugs are not always the best choice for treating chronic pain, as they can be harmful and potentially addicting. Plant-based medications are less risky.
Technology has a place in the modern world. We have no choice but to rely on it as part of our daily lives. But we don't have to let technology be in control. We do not have to let a condition like tech neck make us less comfortable. If you suffer from tech neck, try the three tips described in this post. If you pain continues, feel welcome to visit one of our pain management clinics. They should help you feel better.
