Talking To Your Doctor
It is likely, it has been a long frustrating road for people with persistent pain to see a pain medicine specialist given Australia's shortage; approx. 1 pain specialist for every 21,000 people with persistent pain.
People with pain conditions often arrive at consultations disabled by pain, unable to work, frustrated, depressed and have tried numerous failed therapies so staying confident and buoyant in the face of further medical advice and treatment can seem daunting, however, patients can influence the non-medical effects of treatment which can benefit a return to productive life including return to work.
Positive expectations on the part of the patient before treatment are important and can be one the best predictors for pain reduction. Focusing on, and understanding the explanation for your pain condition, even if a firm diagnosis is not possible can be an important first step towards positive pain treatment outcomes.
At times the advice or information may not be what we have expected or want to hear and this can require reflection and careful evaluation after the appointment. Rash defensive reactions, before we have given due thought to the information may be counter-productive in the long term.
Staying active despite pain has been shown to result in less disability and earlier return to work. Bed rest is not a treatment option generally advised by pain medicine specialists for persistent pain but a pain management plan, including paced physical activity, is often advised for daily living.
Unfortunately, there aren't any classrooms teaching the value of becoming active, participating patients who can confidently and competently state the quality, quantity of pain, onset, duration and impact of the different pain conditions. However, active engagement during the consultation and afterwards, is central to improve pain health as it is for managing any other chronic condition eg diabetes.
Connecting with the pain physician
Busy pain specialist rooms often have time constraints, so being aware of developing rapport and trust can lead to increased satisfaction and fewer problems post the consultation.
A referral may be given to a multi-disciplinary pain management clinic whereby a team of health professionals are there for you and can give more attention to the multiple aspects of pain management. Multi-disciplinary pain management is renowned for measurable improvements in persistent pain.
Fostering trusting relationships with the treating medical specialist can lead to improved satisfaction associated with medical and hospital experiences. Using enquiring and clear communication can
help doctors and nurses hear your concerns and care about your condition, paying attention to your progress or setbacks.
Recognition of your readiness to change your lifestyle/behaviour patterns, or not, can be important information for the pain specialist. Obtaining a referral to other health professionals or using members of your social circle to work through difficulties may be timely. It is often apparent to health professionals when patients are playing 'lip service' to what needs to be done but are not yet accepting that pain management will require active self-care acting in tandem with medical management, for pain reductions to occur.
Emotions are central
Emotional factors play a significant role in pain management and may have a direct effect on treatment outcomes. Being aware of depression and fear of re-injury with return to physical activity or work, for example, can be helped by accessing treatment such as cognitive behaviour therapy and multi-disciplinary pain management. This will give a greater chance for successful treatment compared to medical interventions alone.
An important aspect of the appointment with the pain specialist should be to seek reassurance that the pain is not life threatening or doing further bodily damage, so worrisome thoughts can be calmed. Improvement after treatment can continue to occur if there is the desire to get better, reduced anxiety, increased optimism and improved pain coping.
Each encounter with the pain specialist can be a positive step for future outcomes so communicate your perspective fully and improve your encounter with the pain medicine specialist.
TIPS FOR A SUCCESSFUL APPOINTMENT
- Use pain descriptors (link to pain descriptors)
- Where do you feel pain?
- When do you feel pain?
- How does pain affect you?
- Pinpoint your pain on a scale of 1 – 10
- Book a double appointment if this is your first appointment or if you have a lot to discuss/ask
- Take along a list of words that describe your pain, your past and current medications and all the strategies you have tried
- Stay positive and open minded
Checklist before seeing your doctor
» What do I want to get out of this visit?
» What is the intensity of my pain (today/on average/at its worst)?
» Do I have realistic expectations of medication and pain-management strategies?
» Does my pain change at different times or is it constant?
» What do I need to know from my doctor?
» What am I doing that makes my pain better?
» What am I doing that makes my pain worse?
» Has my pain changed since my last visit?
» What medication or strategies have I tried and how effective were they?