In my last column, I discussed some of the challenges of addressing patients' pain. Your success depends on your patients' willingness and ability to talk about their pain clearly and candidly. To this end, feel free to share this handout-as is, or edited to meet your needs.
Managing Your Chronic Pain
Dear Patient,
Chronic pain is serious business. Whatever the situation with your cancer, we need to address your pain. But here's the problem: Talking about pain can be difficult.
This handout provides 6 tips to help you share with me your chronic pain problem. My goal is to help you discuss this difficult topic in healthy, healing ways.
#1: Learn How to Describe Pain
"Pain" is any sensation that is unpleasant, including achiness, itchiness, tightness, burning, pressure and other discomforts. Pain can seem impossible to describe. But it's not. To prepare for your visit:
* Find a phrase or sentence that captures the pain, so if I were to experience the same pain I would recognize it as the same as yours. Common descriptions include, "like my skin is on fire," "like a tight band in my armpit," and "like an elephant sitting on my chest."
* Write down when you have pain, where it is, what helps it, what makes it worse and anything else that might help me understand.
* Write down how your pain interferes with eating, sleeping, working, playing or relaxing.
* Make a list of responsibilities you can't fulfill and hobbies you can't enjoy because of your pain.
#2: Learn How to Overcome Any Reluctance to Report Pain
Patients often hesitate to talk about chronic pain because they don't want to complain. Or they worry it will distract me from the bigger issue of cancer. Still other patients never mention their pain because they assume pain is expected or untreatable, especially if their pain has been addressed at past visits. Or they decide their pain isn't bad enough to bother their doctors about it.
Overcome any reluctance to talking about chronic pain by reminding yourself that:
* Doctor visits are not social visits.
* Talking about pain with any member of your health care team-especially me-is not complaining; it is reporting vital information.
* From my perspective, chronic pain is no different than bleeding or shortness of breath: They all require medical attention.
* If you notice your pain at all, it has already reached the level where you need to tell us about it.
#3: Learn About the Price of Untreated Pain
Just because you can handle certain discomforts, it doesn't mean you should. The price of not talking about chronic pain includes:
* Missing out on a valuable clue I need to choose treatment for your cancer-or for any other condition-that offers the greatest chance of recovery and the least risk of side effects and complications.
* Draining your physical energy that can be better used for healing.
* Draining your emotional reserves that can be better used for handling everyday stresses and problems.
* Allowing untreated pain to erode hope. All other things being equal, it's more difficult to feel hopeful when in pain.
* Allowing chronic pain to blind you to joys that are still possible each day. We don't want that!! Every day matters.
#4: Learn to Separate Fear and Pain
Many patients feel fearful that their pain is caused by their cancer, even after an evaluation shows it is not. To separate this fear and your pain:
* Acknowledge the connection: It's natural that the same symptom associated with your diagnosis makes you anxious.
* Tell yourself, "Same pain-different problem." Remind yourself that different conditions can cause the exact same symptom.
* Tell yourself, "Different setting-different problem." Take note of differences in your current condition compared with when you were diagnosed. If nothing else, the setting is different because your tests showed cancer causing the problem before, and now they don't.
#5: Learn How to Nourish Hope
No matter how long you've been dealing with pain, don't despair.
* Effective treatment can manage almost all cases of pain.
* A wide variety of medications, tools, and interventions can reduce or eliminate chronic pain.
* Try to be patient. It may take trying five or more different approaches to find the best therapy for your pain.
* Keep in mind that I won't be satisfied until your pain is as well controlled as possible.
* As long as you have any pain, I want and need to hear about it.
* I will refer you to pain specialists if my initial prescriptions and interventions don't provide good pain control, or if you prefer to see a pain specialist now.
#6: Learn to Avoid the Blues
Between office visits, you probably distract yourself from the pain and, when possible, ignore the pain. This is a healthy approach, as long as you are receiving proper medical care.
But for you to accurately report on your pain at doctor visits, you must shift gears and focus on your pain. So don't be surprised if doing the right thing-namely, paying attention to your pain and talking about it with me-causes you to feel troubled by your pain and even a bit blue.
The key is to tell yourself you can stop paying attention to the pain as soon as you leave my office. Go back to the techniques that were working well for you between visits. If the sad feelings don't resolve, we need to know.
What Now?
Cancer threatens your health. Chronic pain threatens your happiness. Working together, we can help you feel better as we help you get better.
At every visit, please help me understand your pain, so I can optimize all your care, including your pain management. Our mission is to ensure all your energies are used toward healing and embracing life today, tomorrow, and every day.