10 Things Never to Say to Your Doctor About Chronic Pain.

10 Things Never to Say to Your Doctor About Chronic Pain.

Editor’s Note: Dr. Radnovich treats pain patients in Boise, Idaho. His practice is well regarded nationally as a leading clinical research site for pain. He has agreed to write some columns for the National Pain Report.

radnovich

Dr. Radnovich

Most practicing physicians are not as warm and accepting as TV’s Dr. Oz. Going to a new doctor can be an intimidating or embarrassing experience. Going to a new doctor because of chronic pain can be even worse.

You’ve probably had at least one bad experience with a physician. Perhaps you were treated in a dismissive or patronizing way or, even worse, you were called  “an addict” or told that your pain is “all in your head”. (More on that in a future blog).

So how to talk with your doctor seemed like a pretty good start to a blog series. Let’s start by talking about ways to improve your interactions with your physicians.

Here are 10 things never to say to your doctor about your chronic pain.

  1. Pain-scaleDon’t tell your doc “I hurt all over”. If you tell me this my next questions are likely to be “do your teeth hurt? Or do you toe nails hurt? Or do your eyeballs hurt? When your doctor asks you “where does it hurt” try to be specific; pick the 1 or 2 most affected areas or the areas where the pain started.
  1. Don’t overstate you pain or overly embellish the description. Years ago, while working in an ER in St. Lucia, a farmer came in complaining of pain in his rectum “like a chicken bone stuck sideways up there”. Well, as it turned out he did. But most of the time try to use simple descriptors like ‘sharp’, stabbing’, ‘dull’, or ‘achy’.
  1. Don’t suggest the pain is the result of long ago events, such as “I was in an auto accident 30 years ago” or “I fell of the swings”. Right. And who did not fall off the swings when they were kids? There are some health professionals that reach back and attempt find a ‘reason’ for the pain. In my experience, these usually mislead from the true cause of pain and result in ineffective, unnecessary treatment. A previous event or injury can be significant if you had specific, continuous pain in a specific spot since the event. Other than that, these types of explanations tend to be counterproductive.
  1. Don’t say anything related to a work injury or auto accident, even if that is truly how the pain started. Sad but true, saying that your pain is from an auto accident or work injury will likely result in the doctor thinking that you are exaggerating your problems for “secondary gain”, like trying to get a big cash settlement.
  1. Don’t ask for a specific pain drug. Nothing says ‘drug seeker and abuser’ to your doctor faster than saying the only thing that works is Percocet. You are establishing a relationship and asking the doctor for help; not asking for a specific treatment plan. It is counterproductive to pronounce what she should give to you. Especially if that is opioids. Let the doctor come up with her own treatment plan. Yes, it is frustrating and may take longer, but in the end you will establish a good relationship and may get a better care.
  1. Don’t volunteer to your doctor that you do not abuse drugs or that you are not an addict. If you blurt out such statements, she will assume that you do and that you are.
  1. Don’t tell your doctor that you have tried everything. Terrific, if you tried everything and you still have pain; why are you seeing me? Clearly I must have something you have not tried. Make a list of treatments and medications you have tried. Let the doc decide if that is truly everything and if she has anything else to offer.
  1. Don’t insist on getting a specific lab, MRI or other test. It is okay to mention other doctors’ ideas, but that may trigger a defensive response from the new doc.
  1. Don’t tell the doctor you are allergic to everything; particularly anti-inflammatories, gluten or vaccinations.
  1. Don’t say anything about a diagnosis or treatment that you found on the internet or from TV. Doubly true for anything you saw on ‘Dr. Oz’.

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There are 9 comments for this article
  1. Wayney at 12:05 pm

    I am so glad my pain doc is totally different than what is represented here. He believes in educating a patient. He asks questions and listens to my answers. He’s actually questioned whether I am fully admitting how bad the pain really is. Why? He knows my history well enough to know that having had chronic pain since childhood (that was largely untreated since kids weren’t given pain relief 30 yrs ago when I was diagnosed with JRA). He’s seen the x-rays and MRI that even I can clearly see the joint damage on. Course that could be because my ped rheumy always showed me my x-rays and compared them to earlier ones so he could point out the changes. By the time I was 10, I could find new damage on an x-ray at a glance. He encouraged me to learn all I could. And my pain doc fosters that. As for mentioning a specific med, my pain doc asked me from the early days of my treatment to tell him everything I had been on and what helped and what didn’t and then he asked which of the meds I had been on worked best. He was far from worried that my mentioning a specific medication meant I was drug seeking. He actually had to convince me through education that certain changes were better for me than others. I was far more conservative about meds than he was after seeing my results and imaging. And the cool thing, he is not one of those pill mill type docs who easily lets patients tell him what they need. I’ve heard too many people say he was tough on prescribing. The fact that he is not so tough with me tells me he has a reason for being how he is with me. Of course, he is only the second doc to be as honest as he was about my expectations. He told me on my first visit that he couldn’t get rid of my pain (a fact I was more than well aware of thanks to my prior doc educating me). That impressed me that he did not give me false hope. He said he could reduce my pain to a tolerable level where I could have as good a quality of life as possible while keeping side effects to a minimum. That is part of why I’ve seen him for nearly 10 yrs. Longest doc I’ve had! And I trust him more than most docs. I know if something another doc is a concern to him that I need to be concerned as well because he has never interfered with another doc’s choices. Once he had some concerns which mirrored mine but were ones that at the time were the better choice of a few that were not quite as good.

  2. Stephen M at 5:18 pm

    I also agree with unhinged about the risks of NSAIDs. I can’t tolerate them, not even a single 200mg ibuprofen. Occasionally, the pain will get so bad, despite my underdosed opioids, that I’ll take ibuprofen knowing that I’ll need diphenhydramine/Benadryl for the allergic reaction, omeprazole for the GERD that NSAIDs trigger, and prayers for the blood loss. Opioids have never caused me to vomit (or otherwise expel) blood.

    Thank you, Maria, your comments perfectly match what I wad feeling when reading this, but couldn’t put into words.

  3. Steve M at 1:04 pm

    I also agree with unhinged about the risks of NSAIDs. I can’t tolerate them, not even a single 200mg ibuprofen. Occasionally, the pain will get so bad, despite my underdosed opioids, that I’ll take ibuprofen knowing that I’ll need diphenhydramine/Benadryl for the allergic reaction, omeprazole for the GERD that NSAIDs trigger, and prayers for the blood loss. Opioids have never caused me to vomit (or otherwise expel) blood.

  4. Steve M at 12:58 pm

    Thank you, Maria, your comments perfectly match what I wad feeling when reading this, but couldn’t put into words.

  5. Maria Brant at 10:03 am

    I found this article just a few days ago through a google alert for “chronic pain management.” It will be difficult to briefly sum up my reactions to it. Many of my responses agree with a prior respondent, Kurt W.G. Matthies, but I think he must be a nicer person than I am.

    Dr Radnovich seems to be telling us about all the things patients say to HIM that he finds annoying and that waste his valuable time. By the way, I have the radical opinion that patients’ time is as valuable as a doctor’s time (both of us being human beings), and if I am routinely kept waiting for more than 40 minutes or so, I find another doctor in that specialty.

    As Mr Matthies’ points said, there certainly are illnesses in which one’s whole body does hurt — and I thought of fibromyalgia as well. There must be many others in which there is widespread joint and muscle pain, for example.

    Sometimes people don’t know how to describe their pain until they have spent a few visits in a Pain Management Office. Then they can be more concise once they understand what is wanted of them.

    Patients probably try to give as much information as they think may be helpful, including long-past information. I’m sorry this annoys the doctor. I have sometimes wondered if that flat-on-my-back fall on an icy sidewalk when I was a teenager played any role in my subsequent spinal degeneration. His advice seems to tell people to make their own choice not to share this information because it’s probably irrelevant, and anyway, it annoys him.

    Some of the doctor’s suggestions clearly come from a belief that most of his patients are lying to him. I find this particularly troubling. This is not the ideal way to begin a doctor-patient relationship. Having been a clinical social worker specializing in treating mentally ill drug abusers, I understand, hopefully, a lot of the possible attempted manipulation that goes along with trying to treat a chronic pain patient. In fact, getting some people in Drug Recovery to take any meds can be difficult because they see all meds as drugs and are anxious to maintain their sobriety.

    What if a pain patient really does know that so far Percocet, using the example, has been the best of a bad lot? Finding out if the patient wants exactly that drug may give you an indication of his motives, or, that it’s been okay but he really wants a more dependable kind of treatment.

    Of course, patients who may genuinely need these drugs will now all want to make sure that they say they are not drug addicts. The popular media is overflowing with the Most Evil Drug of the Moment, saying that anyone asking for two tablets of Percocet or Vicodin for a bad migraine is actually part of a desperate nation of pillheads, all looking for that fix of one more Percocet tablet. Asking for meds that will actually treat episodic bad pain, which I think is what these drugs were created for, is now considered a powerful indication of addiction. There are many pain patients who need these medications but either can’t get them because the patient appears to be an “undesirable risk”,or the local pharmacies don’t want the hassle of stocking a drug that our media now suggests is the best possible drug to steal and get high on, and a potent potential killer (many of our meds are).

    It often feels to patients that they have tried everything over the last two or three or more years they have been seeking help. Give them a break. It’s not a personal insult to the doctor.

    What if you know you do have a bad reaction to a particular anti-inflammatory? Are you supposed to keep this information to yourself?

    I agree with you about Dr. Oz.

    Full disclosure: I was a Clinical Social Worker specializing in working with Mentally Ill Drug Abusing patients in clinic settings. I was warned that it was a burnout job. That part was true.

    I have been a chronic pain patient, suffering from Daily Migraines, since approximately 1991 . I do not remember all the medications and all the doctors I tried. I do remember the side effects and the fact that they did not treat the migraines. I tried many, many alternative treatments, some too embarrassing to mention, but borne out of desperation. I have no idea of how many thousands of dollars I spent or how much work or how many social occasions I missed due to migraines. I once spent a week in the Caribbean lying on the couch with a cold washcloth on my forehead. Thus far, the best treatment I have tried has been Botox injections every three months. No, they do not fill out my wrinkles or make me look younger.

  6. Ray at 9:04 am

    Sherri B., it was Dr. Radnovich who wrote this article. Sorry.

  7. Bill L. at 7:53 am

    Hi Dr. and up front I want you to know I have full body CRPS so when I say it hurts “All Over” I’ve said exactly what I mean.. and since there is no point in trying to target one place over another with my condition all over can be an acceptable answer.. That said of course I give the Dr. the most seriously hurting locations. My question is if the Dr. deals with Chronic pain isn’t he going to be accustomed to patients who’s knowledge of medications and dosages is better than the average person going to a GP for the first time? Please understand that you are speaking to a now opressed minority.. thanks to the FDA & DEAs crusades against Opioid medications every Chronic Pain patient has been made to feel like an addict or drug seeker… I’ll be honest I am an addict and a drug seeker…for without the cocktail of drugs I take each day I would become a scream machine.. it’s happened once when a MRSA infection of my blood put me in 2 ERs in the same day where I spent over 12 hours unmedicated and was under medicated after that for a week. I only know this from friends accounts because my last memory was losing it and screaming in the ER and my friends say kept screaming for a week, they said they could hear me from my far end of the ward room even before they got off the elevator. It wasn’t until they put me back on my “regular” meds that I regained my awareness and control of the pain. Thanks for the advice and sorry if I soapboxed on your blog but Drs need to remind the FDA that patients in pain are fighting to remain sane while going through the most stressful part of their lives and we don’t need the FDA or Drs making things harder than they already ARE!

  8. Sherri B. at 8:02 am

    This is extremely insulting. Be honest with your Dr. Give them all the info so they can accurately diagnose and treat your injury or illness. I personally have seen Dr. Radnovich and can tell you he is the first Dr. Who looked me in the eyes when I spoke and he actually examined my injured limb. He wants your input and respects your ideas and opinions even if that doesn’t match his own. My quality of life is better because of my treatments. He is smart and cutting edge. Please rethink your article. I view it as narrow minded rhetoric from a source that has been under educated.

  9. Unhinged at 10:16 pm

    Thanks, Dr. Radnovich,

    All good comments, about what “not to say”. I am lucky that I have a wonderful doctor who treats my pain, from Ehlers-danlos syndrome, effectively. I do have to so something though, about not saying you’re allergic to anti-inflammatory medication. I have heard that this has been used as some kind of ploy to get opioids. However, this allergy is serious! My husband, who thankfully does NOT suffer from chronic pain, is HIGHLY allergic to NSAIDS, and anything containing Aspirin. He also has Asthma. He is so allergic, that he was in an Aspirin de-sensitization program at MGH in Boston, and had to stop. If you truly have this allergy is can be VERY dangerous to be given anything with Aspirin. He has had two subclavian thrombosis events, due to a structural, rib issue. He finally had a rib removed, but his doctor really wanted him to be on Aspirin therapy. Thus, the desensitIzation program he couldn’t complete. Also, NSAIDs are SO overused in this country, and can be extremely dangerous. Before being accurately diagnosed with EDS by a geneticist, I was misdiagnosed for many years. Doctors had me on maximum dosages of many different NSAIDS over the years, and they were ruining my stomach. Bleeds, Kidney issues, cardiac events, etc.. NSAIDS can be more dangerous than opioids taken long term. Okay… Off the soap box now. Thanks for your support here, Dr.