Empowering Patients to Cope With Chronic Pain

Few things make a person feel as helpless as relentless pain. When you wake up in the morning, the only thing you can be sure of is hurting. How much on any given day may vary.

Will you be able to work today? Will you be able to play with your grandchild, or lift your toddler into the car seat? Will you be able to stand at the stove long enough to cook meals? Can friends come over--or are you living in dread that someone might drop by before you feel well enough to catch up on housework?

For someone who has never lived with chronic pain, it may be difficult to fully appreciate how much it can impact almost every aspect of everyday life.

When aspirin and over the counter pain killers no longer take the edge off, when even the prescription you used next week’s grocery money to buy is hit or miss, when the pain goes on for weeks, months, years—it can become almost as painful to the spirit as it is to the body.

The management of chronic pain is a medical specialty geared to giving people back their lives.

“It’s important to help patients own their pain and give them strategies they can use to deal with it on a daily basis,” Chad Austin, MD, of Alabama Pain Physicians, said. “We work with patients to help them find what works for them.

“The first thing is to make sure we have a solid diagnosis. Sometimes more than one thing may be going on. What at first could appear to be a spinal issue may turn out to be arthritis in the lumbar area, which needs an entirely different treatment.

“Patients who have been experiencing chronic pain for a while may already be taking pain medicines, which can cloud the issue and make the source of the pain more difficult to find. Sometimes we have to work backwards.

“When we have a clear sense of what seems to be happening in that particular patient’s case, we can start putting together the best combination of medications, procedures and support strategies that are likely to be most effective.

“No one single thing is right for everyone and every type of pain,” Austin said. “We use multiple modalities in our practice to attack the pain from several approaches at one time. That may include non-opiate pain killers, antiinflammatories, injections, blocks or radioablation. Bracing, physical therapy and massage may help. The psychology of pain is also an essential factor. Helping patients with the stress, anxiety and depression that come with chronic pain can make a difference.

“Instead of feeling helpless, we want patients to feel empowered. At each visit, we ask them what they are doing to deal with their pain. For some, it may be listening to music or getting involved in hobbies they enjoy. It may be stretching or doing relaxation exercises. Finding what works for them helps them to feel they have at least some power over their pain instead of feeling like a victim of it.

“If other medications are not enough, there are some cases where opiates may be necessary. However, they are never the sole treatment,” Austin said. “If a patient comes back every couple of months asking for a higher dose, that may not mean they are just wanting more of the euphoria that opiates can provide. It could be a sign that their condition is changing or getting worse, and we need to look at that. After a time, they may be developing a tolerance, and we may try rotating drugs or varying the dosage.”

What happens if someone needs an opiate, but can’t take it?

“If there is a history of addiction, Suboxone can be a good option. It blocks the receptors that cause euphoria and will also block euphoria from other meds,” Austin said.

“Overall, chronic pain is treated like a chronic disease. We work to get it stable and knock it down to a manageable level to improve function. Managing patient expectations is also important. Not everyone is going to be 100 percent pain free. Most will have at least some pain, some of the time, but having a plan in place for dealing with it, and knowing that help is there when they need it can make a tremendous difference in quality of life.”

All patients come to Alabama Pain Physicians by referral, and the clinic works closely with the referring physician to coordinate care.

If a physician is considering referring a patient for pain management, Austin advises, “the sooner, the better. If we can start treatment early enough, we might be able to intervene before it becomes a chronic problem.”