Monday, April 19, 2010

Top Ten Reasons Why People Seeking Treatment for Chronic Pain Just Can’t Win

  1. When it comes to describing chronic pain, the 1-10 pain scale is completely useless.  Among myriad other problems (including the fact that it’s subjective and relative), it lacks the capacity to reflect the devastating effects of enduring unrelenting pain over long periods of time.
  2. The 1-10 scale has become a psychological guessing game.  Pick a number too low, and the doctor or nurse treating you is likely to respond, "A three? It’s a THREE man, a THREE. Get a hold of yourself! For threes, we use Tylenol. Here' s your paper. See the clerk out front."  Respond with a number that they think is too high, and you’re deemed to be a drug-seeker, a drama queen, or a faker because anyone who “really had pain that was an eight/nine would be [insert particular behavior the medical professional feels all people who are really in severe pain exhibit].”
  3. If you refuse to use the 1-10 scale to rate your pain (see items 1 and 2), you’re uncooperative and won’t get treated.
  4. When you go to the Emergency Department (ED) because your regular pain medications aren’t helping, admitting that you take strong narcotics is viewed as proof that you’re a drug-seeker and you don’t get treated.
  5. If you don’t admit that you already take strong narcotics when you go to the ED because your regular pain meds aren’t helping, you won't get treated with drugs that are appropriate for someone with a high baseline tolerance level.
  6. If you tell a doctor that what you want are pain meds that work without causing dependency, sedation, or other harsh side effects (like chronic constipation, weight gain, dry mouth) and you’re told you’re being unrealistic.
  7. If you tell a doctor that you want to try opioids or need a specific narcotic for pain relief, you’re back to being a dismissed as a drug-seeker.
  8. Telling a doctor too often or too adamantly that the pain meds s/he’s prescribed aren't helping and you’re still in severe pain is evidence of drug-seeking behavior.
  9. Telling a doctor that you can barely make it to your next refill is evidence that you’re either diverting your meds or abusing them, which is of course evidence of drug-seeking behavior.
  10. Telling a doctor that you save your narcotic pain meds for the times when you really, really need them and you’re hoarding meds, which is also drug seeking behavior.
The moral of the story is that there is no way for people in chronic pain to win with some doctors. All too often, they’ve made up their minds about us before they’ve even talked with us, and nothing  we do, say, or explain will change their opinion.

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