Pain Patients And Pill Limit Pushing


I continue to be amazed at the number of pain patients, both mine and others that I meet who do not understand the use and power of their medications. Pain medications, either opiate or anti-inflammatory in nature, can only do so much for the patient with chronic pain. Patients seem to be in continual pursuit of better and better pain control, at least until they are placed on opiate medications. Then for some reason they change and begin to pursue higher doses instead of realizing they need to coninue to work on alternative approaches. With opiates they seem to believe that their pursuit is finished and somehow believe that the answer lies in the pills alone. The most any medication can do is lower your pain levels by 1 or 2 steps on a pain scale of 1 to 10. In other words, if your pain is a level 8 on the average on a scale of 1 to 10, the most a medication can do is lower it to a 6 on the average. With this much help, perhaps the patient can become more active to the point where they can work on conditioning themselves, becoming more active, or continue working for a living. But they will not achieve a pain level of zero, no matter how much medication they take.


Many patients, though, do not use the medication to their advantage. Pain, after the time of acute injury, is a warning sign whose time has passed. Originally it is useful to the brain to warn it of the new injury. But once the injury has healed (3 to 12 months depending on the injury) pain becomes a symptom only. It no longer is a warning to the brain, but instead is just a reminder of tissue or nerve changes. Too many people place great value on that symptom however, and allow the pain to constrict their daily activities. Instead of pushing through it and working to better their lives, they give in to the pain and become even less conditioned and more disabled. I believe a lot of this is due to our modern lifestyle. In today’s environment we are “allowed” to become disabled and remove ourselves from social and physical activity. This only brings the pain more to the forefront as we remove ourselves from the distraction of work or family activities.


For years I sympathized with the patients thinking I could gently remind them and cajole them into further activity. Too many patients took this attitude as one of being overly sympathetic with their pain, and used it to justify their own further inactivity. Dealing with my own chronic pain from a herniated disk and degenerative disease in my neck and back perhaps made me too sympathetic. It was hard though on the days when I came to work bent over and “disabled” myself with difficulty even walking from exam room to exam room to be more sympathetic with the patient’s complaints. I knew for myself that work and activity was distracting from my pain, and became frustrated with the patients who simply were using their pain as an excuse to remove themselves from society and or activity.


The human brain is capable of incredible feats of control. We have seen this in our athletes and warriors for generations. Pain is simply one of many signals to the brain and our thought and subconscious processes are fully capable of placing pain into its own compartment where it can be ignored and worked around. I have been trying to come up with a way to teach this idea to patients to allow them to work around their own pain. But it seems too many of them have allowed pain to wrap them up in it’s enveloping embrace.


Now I am recommending meditation, or a meditation based yoga practice to perhaps allow the patients to learn how to separate their thinking process from their emotional reactions to their pain. There are many teachers out there, and patients should seek their own in their local community. But for the pain patient to simply take their pills, and assume that is the best they can do, has become ultimately so frustrating to me as a practitioner that I have become to think that I am an enabler instead of a physician trying to help people. I know there are multiple paths toward normal function, and that the medications are simply one step towards finding the patients path. My ability to convince patients of finding alternate paths continues to be frustratingly poor however. For now I will continue to work to find a solution for each patient, but the task is frustrating and is wearing on my own mental function at times. Perhaps it is easier to take the path of least resistance, and instead of crusading for improved care I should rejoin with the massed doctors out there in a group and return to assembly line medicine. It is frustrating to not see patients seek improvement in their chronic conditions day after day after day.


Filed Under: Dr.s Notes


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August 18, 2011