When the doctor says, rate your pain on a scale of zero to 10, do you know what to say?
A zero is pretty easy to figure out, and a 10 is the worst pain you’ve ever had. In between, who knows the difference between 3, 4, 5, and 6?
For a short-term intense pain, say in childbirth, your best guess at that moment may be fine. And all you need is relief. But if you’re among the estimated 23.4 million adults who experience a lot of pain over months, more than 10 percent of the population, your doctor really needs to know how that pain is affecting your life and help you come up with a package of solutions both to reduce pain and cope.
In a New England Journal of Medicine editorial, Jane Ballantyne, MD, and Mark Sullivan, MD, argue that the sole focus on pain in the current scale has nudged doctors into prescribing too-high dosages of painkillers to patients with daily pain. Patients run the risks of side effects, including overdosing and even death, and also may not fully explore other options.
After all, a more potent prescription may reduce your pain but, if it makes you groggy and you can’t drive safely at night and end up feeling isolated, your pain could get worse when unmedicated, and you’ll need more painkillers to cope.
That’s one reason the American Chronic Pain Association has created a quality-of-life scale to replace the pain-intensity scale, which you can print for reference. This time, zero corresponds to “stayed in bed all day,” 4 means “Do simple chores around the house. Minimal activities outside of home two days a week,” and so on, up the scale. To judge your number on this scale you can look at your calendar and ask your spouse. Bring it to your appointments. On repeat visits, your doctor can see whether you’ve improved in the way that counts most — staying engaged.
Don’t be ashamed of taking drugs if you need them. Your chance of becoming someone who abuses painkillers are tiny if you have no previous history of substance abuse. But if you do have addictive tendencies, that number goes up to around 11 percent. Either way, see a prescription as only one step. Many chronic pains begin with an acute pain — from an injury. When pain signals are repeated over and over, your brain may begin a process that is something like encoding them. As studies using brain-imaging technology suggest, over time we also may begin to experience pain from emotional triggers. These are both reasons chronic pains can last long after the injury is healed.
That sort of pain is harder to diagnose or treat, and pain sufferers are too often met with disbelief. How insulting to be told a pain is “all in your head”! It isn’t imaginary. The truth: a link to emotions doesn’t make a pain more comfortable or mean you’re not eager to pursue your life. It does mean that you may need to directly address emotional issues and guard yourself against letting pain push you into depression.
As a woman, don’t compare your experience to your husband’s. Women may become dependent on prescription painkillers more quickly than men. They are also more likely to have chronic pain, get a prescription painkiller, be given higher doses, and use them for longer time periods.
If a different prescription will allow you to work more hours or have a social life, it’s a good idea. If changes in diet, a support group, meditation, massages, or spending time with a dog also move you up the quality-of-life scale, that’s even better.
Foods that are generally good for you are often anti-inflammatories that fight pain. These include cherries, spinach and kale, almonds and walnuts, soy, and fatty fish like salmon and sardines.. Consider cutting out sugar and alcohol.
The American Chronic Pain Association offers a variety of free tools you may print out or use online, including a map of your back to pinpoint pains, an “ability chart” to identify tasks that are more difficult, a pain log, and more. Some are tailored to people with fibromyalgia, or arthritis, or for all chronic pain sufferers. They can help you explain your pain to your loved ones and doctors.
The group encourages its members to play: with jigsaw puzzles, coloring books, singing to music, window box gardening, and simple wood working.
All of us could do more playing, since play and laughter are therapeutic. And all of us need to know that when we have acute pain — say, an aching knee — it might ordinarily last between five and 10 days. If it doesn't improve in three weeks, check with a pain specialist. You don’t want to “teach” your body the pain signal.
May 19, 2016
Christopher Nystuen, MD, MBA