Have you ever sat in your doctor's office, your carefully planned speech about your pain completely vanishing the moment they walk in? You're not alone.
For millions of Americans living with chronic pain, communicating with healthcare providers can be an overwhelming experience that often leaves them feeling judged and unheard.
The Impact of Chronic Pain: A Growing Crisis
Data from the CDC showed that in 2023 24.3% of adults had chronic pain and almost 10% of adults had chronic pain that frequently limited life or work activities. Chronic pain affects everything from missed job opportunities and/or promotions to social invitations and important family gatherings. These miss opportunities often leave people feeling alone, misunderstood, and highly frustrated.
In this article we explore how you can talk to your doctor about your chronic pain in a way that won't leave you feeling judged or unheard, so that you can get the care and the support that you need to get through this crippling condition.
Understanding the Opioid Crisis and Its Impact on Pain Management
The landscape of pain management has been dramatically reshaped by the opioid epidemic. As of October 2024, FDA data shows that over 6.1 million Americans and more than 20 million people worldwide have dealt with Opioid Use Disorder (OUD).
This crisis led to massive lawsuits against pharmaceutical giants including Purdue Pharma, Johnson & Johnson, Kroger, Walmart, CVS, and other major pharmacy chains.
Unfortunately the opioid epidemic also created a sense of stigma around chronic pain making it difficult for doctors to differentiate between those who genuinely required these pain medications to manage their chronic condition, and those who were seeking the medications for other uses. Fundamentally change around how doctors approach pain management was much needed.
The Growing Stigma Around Chronic Pain (and Chronic Back Pain)
The aftermath of the opioid crisis created an unfortunate stigma around chronic pain treatment, particularly for conditions like low back pain. Research shows that patients who receive long-term opioid treatment for non-cancer pain often discriminated against by multiple sources. Some of these include healthcare providers, family members, employers, and society at large. This stigmatization can trigger depression and anxiety, sometimes even making the pain feel more intense.
If healthcare providers are going to effectively manage these chronic pain conditions, a compassionate and empathetic approach is needed in order to connect with patients and help reduce the stigma around chronic pain management.
When people are made to feel guilty, judged and embarrassed when they reach out for help with their conditions, this can lead to feelings of depression and anxiety that can actually make their pain worse.
Evolution of Pain Management Guidelines
The CDC's response to this complex situation has changed significantly over time:
2016: CDC Released initial guidelines for opioid prescriptions in chronic pain management
Initial implementation led to some unintended consequences
Many patients faced abrupt medication discontinuation
Some cancer and hospice patients couldn't access necessary pain relief
To address this need they released the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. This guideline offered 12 recommendations for primary care providers around the prescription of opioids outside of active cancer treatment or end-of-life care.
The issuing of the guideline was well received and opioid use numbers dropped dramatically. Lawmakers from various states used the guidelines to create regulations and policies around the use of opioids which was, initially, very welcome.
Unfortunately some of the policies that were created were inconsistent with the guidelines and went beyond the scope of what the CDC had originally intended.
No Opioids For Low Back Pain
By stepping outside of the original scope of the guidelines, some cancer patients and palliative care patients ended up not being able to receive opioids for their conditions. Other patients found that their medication was abruptly stopped and not gently tapered down as had been recommended by the guidelines.
These extreme measures left patients with untreated (or undertreated) pain and intense withdrawal symptoms, along with psychological stress, and sometimes even suicidal ideation. This was obviously not what the CDC had intended for chronic pain sufferers.
The CDC then created a new clinical practice guideline which was then reviewed by an independent federal advisory committee and included insights from patients, caregivers, and clinicians. These new guidelines still provide recommendations but now there is more room for individualized care and patient-centered decision making rather than rigid rules that were a one-size-fits-all type of treatment.
What Do The CDC Guidelines Mean For Me?
Hopefully the introduction of the new clinical practice guidelines from the CDC give providers more scope to make personalized recommendations around pain. It is also hoped that the new guidelines are a step in the right direction to help reduce the stigma around the use of opioids and those who need them.
How Can I Talk To My Doctor About Chronic Pain?
Now that the stigma aspect has been addressed, there are some things that you can do to help your doctor have a better understanding about your personal experience with chronic pain.
Use A Pain Scale
When you meet with your doctor one of the first questions they tend to ask is for you to rate your pain on a scale of 0-10. “O” indicates that there is no pain at all, while “10” is generally regarded as indicating the worst pain you can imagine.
Unfortunately, this type of numerical rating often doesn’t do a good enough job of describing pain. Using a numerical scale is often too simplistic. Some patients might think that they can’t possibly use a “10” even though their pain is causing them significant distress. This could end up in a patient “low balling” their pain levels and not getting enough medication to properly address their pain.
And it's not just your comfort level that is affected - your treatment could be compromised. If patients aren’t receiving the right treatment for managing pain, they might not be able to keep up with their physical therapy exercises which can then make their recovery process much slower.
Different Types Of Pain Scales
Fortunately researchers have come up with several different pain scales that can help patients describe their pain more comprehensively to their doctors. Some of these scales include:
Scales like the VAS and the Wong-Baker FACES scale show faces that range from happy to crying which helps people put a more visual aspect to rating their pain. The more descriptive and accurate you are in communicating with your doctor, the better their understanding will be of how bad your pain is.
The Oswestry Low Back Pain Disability Questionnaire
The Oswestry Low Back Pain Disability Questionnaire is another useful tool that can help to create a more comprehensive picture of your pain experience. This questionnaire has been designed to give your doctor information about how your back pain has affected your ability to manage everyday life. Knowing if walking is difficult but possible, or simply completely out of the question, can help your doctor find a pain solution that is tailor made for your situation.
Consider What Sort Of Pain Treatment Options Are There Other Than Opioids?
Fortunately research is providing doctors with a multitude of pain reducing options that do not involve medication. Some of these treatments include:
Deep breathing
Cognitive Behavioral Therapy (CBT)
Chiropractic Care/ Spinal manipulation
We are seeing more and more evidence surrounding what is known as the ‘biopsychosocial approach’ to pain management and care. By taking into account the psychological condition and the emotions and stress levels that a person is feeling, doctors are able to help lower those stress levels and reduce feelings of pain. This model is becoming more widely used as the evidence behind it grows.
Conclusions
Chronic pain can have a devastating impact on quality of life and it is important that patients are given the chance to really describe their symptoms without fear of being judged or stigmatized.
Treatments like biofeedback, physical therapy, and cognitive behavioral therapy have been proven to help patients manage their chronic pain without the use of dependence-producing medications.
Doctors need to check their own biases when dealing with chronic pain patients and make sure that they listen properly and openly so that patients can feel heard and can properly describe their pain for the best possible treatment outcomes.
If you are struggling with chronic pain, make sure that you use tools like pain scales to help you describe your pain. If you don't feel like you are being properly heard, don't be afraid to find someone who will listen to your concerns and help you find the best treatment.
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