Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain - Michael K. Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin (2012)

Chapter 5. Working with Your Doctor

When your doctor was a medical student, pain management as we know it today, was probably not taught in great depth. There have been many changes since then, including more availability of specialised training and recognition of the need for multidisciplinary teams to help with the complex problems of people with chronic pain. A typical ‘team’ in a hospital pain clinic would be a medical specialist, a clinical psychologist or psychiatrist, a physiotherapist and a nurse. Other health professionals, such as social workers, occupational therapists and dietitians, may contribute as well. For best results, a hospital team should work closely with your family doctor as he or she is the health care provider who is closest to you and will be able to provide ongoing and readily available help.

Not all people with chronic pain need to see a multidisciplinary team at a hospital, but they are available if your doctor thinks it might help for you to see them. However, even the people who have attended our ADAPT program, which is in a hospital, are strongly encouraged to maintain close links with their doctor in the future, for as long as their pain persists.

It is important to establish a good ‘working’ relationship with your family doctor. This is particularly so when you have to manage a chronic problem for which there is no cure, such as diabetes, heart disease, asthma or chronic pain. For chronic pain, it is important that the individual continues to function and manage the pain in the best way possible, and this requires an active approach. Instruction is needed on how to best manage persisting pain. Most family doctors encourage activity despite pain (unless there is a good reason to rest), and sensible use of pain killers. Through their experience and training they will recognise those who are doing well and those who need more help than they can provide. If you are not doing as well as you would like or should be, then you are likely to benefit from the help of a multidisciplinary team.

Getting the best from your family doctor

Keep in regular contact with your doctor

It is best to think of the family doctor as your doctor, with all other health professionals providing specialist opinions and treatment. Your family doctor is not a mind reader, so you will need to be clear about your pain. They can’t know what you don’t tell them. Keep your doctor informed of any changes in your pain or function and make sure that you ask for regular reports from other health professionals to be sent to your doctor. If you see a new doctor, make sure that you tell your family doctor. If you feel that you are not making enough progress then discuss getting a second opinion.

See your doctor on good days too

Avoid just attending your doctor when you are in more pain or really distressed. This unfortunately only allows the doctor to manage the crisis that they are presented with. By seeing your doctor on good days other areas can be explored with you without pain and distress being such a major factor. A major crisis should be followed by an appointment to try to work out why it occurred and how best to manage such a situation in the future. Often a crisis is brought on by things such as poor planning, not pacing activities, unhelpful thoughts and lack of use of stress management skills. These are all things that you need to do. Nobody else can do them for you. 

Make notes before you go to the doctor

Write down any questions you would like to ask your doctor as they come to mind. This is helpful for your doctor too. If you don’t, you are likely to forget something that has been bothering you. Remember, your doctor has many patients and if you don’t ask something he or she might assume that you know all about it.

Remember that your doctor is human

There are only certain things that your doctor can do to relieve your pain. ‘Quick fixes’ are rare. You may feel that your doctor is not doing very much, when in fact your doctor may be waiting for the natural history to take its course and for you to get better. Your doctor will try to help as much as possible, but you must also look at what you are doing to manage your problem as well. Try to work with your doctor on these problems rather than expecting your doctor to have all the answers and that it is their responsibility to fix the problem for you.

Be honest

Sometimes when people are distressed by pain they will do things that are not in their best interests long term. For example, they may take more than the recommended dose of a drug or even take drugs that have been prescribed for a family member or friend. Your doctor needs to know about this so that they can help you.

Be realistic

There are only certain treatments for persisting pain, and many of them have only a small success rate. Very few are likely to totally relieve pain, although new treatments are becoming available all the time. Remember, all drugs have side effects.

Look at your own pain management

There are a number of things that you can do to manage your pain. This is called active pain management and is, of course, the subject of this book. Let your doctor know about your achievements in managing your pain. Try not to focus solely on the problems and failures. Recognise your achievements too.

Feel confident to reject a treatment

You may need to work out ways of saying no to offers of medication or treatment that you are not interested in. Your doctor will be pleased to see you taking more responsibility for managing your pain, since doing so also lifts some of the burden off their shoulders. This can help in making your relationship a more equal, collaborative one, rather than a one-sided arrangement where the doctor feels everything is up to him or her to solve.

Questions to ask your surgeon

If you are considering surgery, it is very important that you find time to discuss the risks and benefits of surgery with your surgeon well before you are admitted to hospital. Avoid, if possible, having these discussions the night before your operation. Most surgeons will try to answer your questions but remember that they may not have all the answers as the full picture may not be available. Research is constantly taking place so more answers will become available over time.

Clearly, you need confidence in your surgeon. If you are anxious about whether an operation will help or feel that the odds are not good enough, then consider getting a second opinion from another surgeon or explore other ways of managing your pain. Suggested questions:

1 What is the success rate of this operation?

2 What is the chance of my pain being completely cured?

3 What is the chance of my pain being reduced by half?

4 If my pain is cured or reduced, how long will this last for?

5 What is the chance of my pain being worse?

6 What other complications are there?

7 Will I be able to reduce any medications after the operation?

8 Is there any other way that my problem can be managed? 

Remember, the answers to all these questions may not be available. This does not mean that you should not go ahead with surgery. Have realistic expectations and if a cure is unlikely, prepare yourself mentally and physically to manage any pain that remains after surgery.