Do you ever suspect that your doctor thinks you are a pain, rather than in pain?
Hint: it’s highly unlikely your doctor feels that way. Still, I often hear from patients who feel like their chronic pain endlessly frustrates their doctor. I’m not a doctor myself, but I happen to come from a family almost drowning in them – parents, brother, uncles, aunts, cousins, maybe even an evil twin I don’t know about. If someone gets a paper cut or a bruise at a family reunion, it’s like someone pushed the Doctor SWAT Team Button and physicians start swarming from all sides. So while I can’t speak directly for physicians, between my family and my career in healthcare, I can offer some educated guesses about why doctors sometimes behave the way they do when it comes to chronic pain.
For one, pain challenges one of the main reasons people become doctors (or any other health care professional for that matter): to help people get and stay healthy. After having accumulated a decade or more in training and hundreds of thousands of dollars of debt, doctors expect to have the expertise to heal and to treat.
But chronic pain can throw that expertise into a tizzy, as it challenges some of the basic principals of a medical education. Modern medicine generally focuses on understanding the root cause of a symptom, rather than just focusing on the symptom itself. For example, we’ve done a great job of eradicating polio, not just by addressing the symptoms, but by tackling the root cause through a vaccine that prevents the virus from spreading in the first place. Additionally, modern medicine thrives on objective measurement: for example, a doctor can measure a patient’s average three-month blood sugar using a test called the Hemoglobin A1c, and then work with the patient to improve the A1c for the next test.
Chronic pain, because it’s so complex and because it tends to outlive the injury that caused it – if there was an initial injury – can make identifying a “root cause” extremely difficult. Additionally, there’s no objective measure of pain experienced (yet), in the same way we can get a heart rate, a blood pressure number, an A1c level, or many other measures. Instead doctors rely on subjective measurements, which require a different approach to diagnosing and treating the condition. It’s also worth noting that there hasn’t historically been enough training on pain management in medical schools. One estimate suggests that veterinary students get five times more training hours on chronic pain than medical students (maybe that’s why Fido’s always in such a good mood…). These factors can all combine to put doctors in a situation they’ve committed countless years of their life in an effort to avoid: being unsure how they can best help.
Of course, there’s also the issue of opioid abuse. When you read this, you may point out that you’ve never abused prescription drugs, that you’ve always taken them at the right time in the right amount, and that you’re obviously an upstanding citizen – so why don’t you get treated accordingly? Of course you’re right, it’s not fair; but opioid addiction and abuse strike in ways that are very hard for health care professionals to predict. People of different races, of economic status, of geography, those who grew up in good homes and those who didn’t, can all become crippled by addiction. Someone who’s ordinarily a saint can turn into a monster when their craving hits, because addiction can temporarily rewire our brains to act in ways that would otherwise horrify us. As a result, all doctors who regularly prescribes pain medications have stories about being duped by people they never would have expected it from. In addition, prescribing guidelines and laws, in response to opioid abuse, have become tighter, making it harder, and often professionally very risky, to prescribe pain meds. The end result is to put doctors, and anyone else who writes pain prescriptions on guard.
At the end of the day, YOU are the person in pain, and you deserve respect and empathy from your caregivers. But it can also help to understand the challenges your doctor faces, and to remember that your doctor genuinely wants to help.
Firth, S. (2016, May 02). Medical Schools Boost Pain Management Education. Retrieved May 30, 2017, from https://www.medpagetoday.com/publichealthpolicy/medicaleducation/56025
Mezei, L., & Murinson, B. B. (2011). Pain Education in North American Medical Schools. The Journal of Pain,12(12), 1199-1208. doi:10.1016/j.jpain.2011.06.006
Rodolico, J. (2016, January 11). Anatomy Of Addiction: How Heroin And Opioids Hijack The Brain. Retrieved May 30, 2017, from http://www.npr.org/sections/health-shots/2016/01/11/462390288/anatomy-of-addiction-how-heroin-and-opioids-hijack-the-brain
Salk Institute. “About Jonas Salk.” (n.d.). Retrieved May 30, 2017, from http://www.salk.edu/about/history-of-salk/jonas-salk/