Pain Management

Engaging Patients in Pain Management

I woke up yesterday with a pain in my neck. I hate when that happens. It’s annoying; it feels like I have to turn my entire body just to look left. But, on the pain scale, my pain is a one—it’s probably closer to zero—and it will go away soon. But imagine if nearly every day you woke up with pain closer to 10 on the pain scale. What would that do to your life? Could you work? Could you take care of your children? Could you function like you do now? I don’t think I could. What’s really troubling is that over 1.5 billion people in the world suffer from chronic pain. In the U.S., more people suffer from chronic pain than diabetes, heart disease, or cancer. That is alarming.

What’s also alarming is the opioid epidemic. Drug overdose is the leading cause of accidental death in the U.S. Many of these deaths are related to prescription opioids or heroin (which is also an opioid). You can probably think of someone you know that has felt the impact of opioids; I know I can. So there’s no doubt that opioid addiction is a serious problem that needs to be addressed.

But we can do more than simply to suggest banning opioids. This is a shortsighted response that fails to consider the needs of the 100+ million Americans in chronic pain. Kate Nicholson, a disability rights attorney and chronic pain sufferer, recently delivered a TED talk that really got me thinking about what we could do to better engage patients about pain management – check out her talk, “What we lose when we undertreat pain.”

Since seeing her talk, I’ve been thinking about ways to engage patients in conversations about pain. Here are three things to consider.

  1. Increase provider education about pain management

The good news for providers is that the increased awareness about opioids has led to increased medical education about pain management. What’s also encouraging is that this increased education and awareness is making a difference in prescribing habits—opioid prescribing rates have fallen every year since 2013. Certainly, more provider education about best practices in managing pain is needed. But we are heading in the right direction.

  1. Change the public’s expectations about pain management

Many patients immediately think that strong medications are the only way to manage pain. But for many types of pain (after orthopedic surgery, for example) there many other options, like elevation, icing, heating, and non-addictive pain medications. So educating the public that opioids are the last resort—that they are very addictive and may kill you—can help reduce patient demands for opioids and help elevate the decision to take them to the seriousness it deserves.

Also, many patients think that pain management means going from an eight on the pain scale to a zero. This isn’t always possible. So reframing the messaging about pain is critical. The message needs to be that, in many situations, some pain is normal and expected. Doing so can help reset patient expectations and lead to better conversations about how to manage pain.

  1. Engage chronic pain suffers differently than those in acute pain

In my view, how we engage patients about pain depends on if they are currently managing pain or if they are new to pain management (or in acute pain). For patients who are new to pain management or in acute pain, changing their expectations about pain management, as mentioned above, is key.

But for patients who are already on a pain management plan (which may include opioids), this may not be enough. Certainly, reframing the message that some pain is expected and opioids should be the last option may help in weaning these patients to a non-opioid option, but more is needed. What clearly won’t work is ignoring patients in chronic pain – or not accepting them as new patients. Sadly, that has become the norm in many parts of the country.

Empathy is what we need to add to the equation. For many in chronic pain, any talk about changing their pain management plan may make them shut down because managing pain is essential to living their lives and they are afraid to tinker with what is working. I don’t think many people understand this or appreciate this. I know I didn’t until I started asking. We need to do more to raise awareness about what those in chronic pain are going through. We cannot truly understand or empathize until we listen. If we do that, then we can learn how to overcome the barriers to change and better engage those suffering from chronic pain.

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Christopher Trudeau, JD Christopher Trudeau, JD, has a dual appointment as an associate professor in the UAMS Center for Health Literacy and as an associate professor of law at the UALR Bowen School of Law. Chris is an expert on health literacy, plain language and the law. His views are his own; they do not necessarily represent those of his employers. He may be reached at ctrudeau@uams.edu.

Christopher Trudeau, JD has 6 post(s) at EngagingPatients.org

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2 Comments

  • David Cole says:

    There’s only one thing that needs to happen, drugs need to be legalized in the United States and government needs to get out of our business. 312 people died out of every hundred thousand in the u.s. due to an opiate related death, now let’s look at countries where they’re legal, Portugal 6 France 7 Italy 8 Belgium 9 Spain 15 and it goes on and on. There are a hundred and fifty million people in the United States that can take opiate pain medication and not become addicted, there are two or three million that do. So let’s not restrict pain medication from the majority because of the minority. The CDC FDA DEA state and local governments are all fixing the books to fit their agenda. Now that we have good people like yourself changing their minds and actually looking at the data, we find lie after lie, just like 66,000 people die of of an opiate related death, the fact is CDC said there was only fifteen thousand, you can’t say somebody died of an opiate related death when they were run over by a car, just because they happen to be taken opiates. I could go on all day about their lies and half truths, however all it does is make me angry and add to my pain. As far as I’m concerned the CDC FDA DEA state and local governments are guilty of murder, and should be issued the death sentence for every chronic pain patient that’s committed suicide.

  • Granny Ralls says:

    Agreed! This has more to do with Big Pharma over charging America and (private and public) insurers not wanting to pay the bill!

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