23 Tips to Help Get the Best Chronic Pain Treatment from Your Doctor

23 Tips to Help Get the Best Chronic Pain Treatment from Your Doctor

Chronic pain appointments can be difficult for both patients and doctors.

For patients, doctor visits can be intimidating and create anxiety.  We want validation of our pain, empathy, answers, and support.

For doctors, chronic pain patients can be more challenging to treat than other patients.  We can be demanding of their time, attention, and patience.

While they truly want to help, doctors often have limited training (typically 11 hours of pain education in medical school), limited time (18.5 minutes per appointment), as well as limitations due to government and insurance guidelines.

So, how do you make the most of your appointment time and get the best treatment when you visit with the doctor?

Below are 23 suggestions to help maximize the patient-doctor experience  (thanks to the many ideas provided by members of the Chronic Pain Champions – No Whining Allowed Facebook support group):

In general

  1. Don’t bring any bad experiences you may have had with other doctors to your appointment.  You don’t want to muddy your doctor relationship.  Start with a clean slate.
  2. Go with a stated purpose but don’t go with any pre-conceived expectation about getting a certain treatment, like opioid therapy, or a specific diagnostic test, like an MRI.  Unfortunately, there isn’t an easy answer for chronic pain.  It’s not like prescribing an antibiotic to cure an infection.  Most chronic pain doesn’t have a cure.  You may not be able to be fixed.
  3. Ask your doctor about arranging recurrent appointments (quarterly, etc.) just for pain management as well as scheduling extra time, if needed, for those appointments.
  4. If you’re seeing the doctor about other medical conditions unrelated to your normal chronic pain, don’t talk about your chronic pain.  Keep it for your regular pain visits.
  5. If you find you and your doctor aren’t a good match, then keep looking for another provider.  Some patients have found a nurse practitioner a viable alternative to a physician.  There are a variety of healthcare providers available to team with.

Before the appointment

  1. Make a prioritized list of topics/questions you want to cover at the appointment. That way you won’t forget things and you’ll stay focused.
  2. Draft an alphabetical list of medications (including over-the-counter medications/supplements). Include the medication name, the dose (such as 5MG), how many pills you take and how often you take them, as well as the name of the doctor who prescribed them.  Include any drug allergies on this list.  Download this free template.
  3. Put together a medical summary of major health events, medical conditions, surgeries, and special treatments related to your pain condition. Make it easy to read and keep it short, one- or two-pages, so the doctor can get a quick snapshot of your past history.  Download this free template.
  4. Arrange for a family member or other trusted person to go with you to the appointment to be a second set of ears and take notes.
  5. If you hear something you think might be helpful in your diagnosis or treatment, take time before your appointment to find evidence-based scientific research to support it (Google Scholar is a good search engine for this).

At the appointment

  1. Arrive early and bring all required office paperwork, including your insurance cards.
  2. Give your prescription list to the nurse to help them reconcile your medicines.
  3. Share copies of your prioritized list of topics to cover at the appointment with your doctor and support person.
  4. Bring a copy of any supporting research to give to your doctor. Be prepared to talk about it.
  5. If visiting with a new provider, bring your medical summary and any relevant diagnostic tests like x-rays.
  6. Be blunt and to the point when talking but stay non-emotional, respectful, and factual. No drama, whining, or catastrophizing about the pain.  And don’t get angry or be rude.
  7. Talk to your doctor about what is happening in your life and how your chronic pain is affecting it. Pain isn’t a just number on a pain chart.  It’s a biological, psychological, and social experience.  Talk about your emotions, your ability to work, your relationships, and your ability to do daily activities.
  8. Be specific when describing your pain symptoms. Tell the doctor when the pain started and how it started, what kind of pain you’ve been feeling (aching, throbbing, sharp, burning, pins and needles, shocking, numbness, etc.),  how often you experience the pain, where the pain is located (lower back, head, etc.),  and what you’ve done to help reduce the pain (ice, heat, etc.).
  9. Talk to your doctor about treatment goals and both medical and non-medical treatment options. Once pain becomes chronic, the ultimate goal of treatment is often increasing functional ability and quality of life, not pain elimination.
  10. Be open to discussing any suggested treatment recommendations and work with your doctor to find the right treatment plan for you.
  11. Clarify and confirm. Ask questions if you don’t understand something.  Repeat what you heard to make sure you heard it correctly.
  12. Be patient as a patient. It may take several doctor visits and/or different treatments before you recognize improvement.
  13. Be grateful. Thank the doctor.

Bottom line

To get the best treatment from your doctor, be prepared, calm, engaged, insightful, and open to taking more self-responsibility for your own care.  It’s harder for doctors to treat patients who are negative or who expects the doctor to fix all of their problems.

I hope you find these tips helpful.

If you want to learn more about chronic pain and the biopsychosocial approach I take to coping with my chronic pain, download a free e-version of my new book Chronic Pain Won’t Stop Me.   And be sure to check out my website Chronic Pain Champions as well as my Facebook support group  Chronic Pain Champions – No Whining Allowed.

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Authored by: Tom Bowen

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Linda G Back

I’m stuck with whatever doctor I’m able to get to treat me. In Michigan changing pain doctor raises red flags, regardless of the reason. They’re tracking us to see how many doctors we see, pharmacies we use etc, it all counts against us.

Dedra Farr

Thomas J Kidd….may I suggest you get away from Humana. I refuse to go t an advantage plan. Try switching to med a gap. You choose a insurance company and a perscription plan seperatlely. I use Aetna and silver scripts. You can enroll anytime. Check it outmaybe talk to SS. You can research it online! Good Luck

Thomas Wayne Kidd

Now we are being advised to walk quietly and beg for humane treatment. Cats and dogs receive much better treatment that the sick and dying do. How much longer some of us can hold in this anger and very near rage at how we are being treated. I also have Narcolepsy and I don’t know how long I can fight my central nervous system back. Wouldn’t matter if I should just loose and go berserk. They would probably call the police and allow them to taze me or shoot me being that they actually don’t give a damn about me or anyone who has been taking opioid medications as long as I have. And the fact that they have worked and continue to work to give some semblance of a normal life doesn’t even register on their priorities. Face it people deceive not yourselves, WE ARE NOT IMPORTANT. only the money and the rich lifestyle afforded by that money is actually important. I cannot apologize, I am near the end of my rope. No more BS. I actually perferr death to this inhuman treatment!

#17 is the single most important LEGAL issue relating to pain.

WHAT abilities did you once have, that you longer can do because of the disabling pain you now have?

Mild pain that is slightly annoying; does no measurable damage.

Major pain that limits walking, bending, standing, breathing, or any other vital function of your body is DISABLING. You have a right to do what is necessary to make this disability less harmful to you.

If pain medicine gives you back some of the abilities that you used to have before your illness/injury, then you have a legal right to treatment.

That’s how the Americans With Disabilities Act works.

So stand on your legal rights and get some relief.

Thank you Gail Honadle, i know i have this caused from daily migraines but doctors still live in the dark age of medicine and want to turn it into mental issue only because when you cannot tolerate the medication or it doesn’t work. I had to have surgery to have multiple bone spurs removed that was pinching into nerves when I turn my head took me 3 years to finally get it after to listen to me oh, I had to train myself not to turn my head to the right due 2 the bone spurs digging in and my migraines was caused from a whiplash injury. Now 28 years later I have finally given up I am tired of seeing neurologist they just want to push medication that I’ve already taken or procedures I’ve already done. There is nothing left for me or doctors to do. I also have a friend that has this in she has low cortisol and now has develop parathyroid tumors that causes unrelenting diarrhea and another health issues. I believe this happened to another friend of mine when her medication got lowered multiple times that I mentioned in here till now she’s just a vegetable. Due to uncontrolled pain caused by physicians lowering her medication repeatedly. I cannot thank you enough for this article because I can give this to my doctor’s. You are right there’s no coordination and even if there was doctors are not going to take the time to read medical reports.

I agree w/ your response Gail Honadle. I now have Physicians traumatic stress disorder from being yelled at, lied about, sexually harassed while getting a spinal injection. Sexually harassed when age 23 from a PT. I will not go into detail but if I did anyone would agree it’s sexual harassment. Ortho Dr. physically hurting me by taking his hand & forcefully squeezing on a shoulder that was hurting bc wanted to see the doctor before I let a nurse (not a PN didn’t exist back then) to put steroids in that was my 1st appt, I didn’t kn what was wrong w/ me to begin w/ was never diagnosed. He had me turn & face the wall & put my hands on the wall & then he took his hand squeezed strong applied pressure & asked me it hurt as I’m yelling. He intended to hurt me bc he was running behind instead of exam a new patient. There was no one but me & the Dr in the room. To recently being misdiagnosed / ignored about what turned out to be 3 blood clots. To this yr being looked in the eye after having hip repair & being told ortho surgeon that he read nowhere in the literature that describes the pain that I’m having. Yet I went to another physician w/o telling him that I had surgery but telling him the pain that I was having an where it was located & him examining me said it was a nerve injury. The very same thing that the PT said. Surgeon ignore my complaints I’m still dealing w/ this sometimes it becomes chronic They like to add ticket items to charge to insurance. It doesn’t save u from needing a hip replacement either like he said. They try to put fear in u to get u to cooperate. Whenever U share w the doctor can be turned around used it agaisnt U. if they can create lies out of their imagination why would you want to give there more fuel. Psychosocial model👎 if it can be done to the any president don’t you think it could be done to you?

Steven

I am supposed to be grateful for 126 mme as opposed to 90 mme. I cannot make it on 126. Period. You mean I am not to mention this little fact at tip two? At most I have a few months to live as my condition worsens. With all due respect we are all short timers exterminated by our own. government for cost savings, carbon savings or whichever.The doctors are supposed to be smart but certainly not pragmatic. Why do they not have a union. One walk out and situation solved. Except Jesus and on the way out at least make a statment.

Dedra Farr

Hayden….where do you live I want to move there. PM here is a joke. You never see the MD after your 1st visit. You see a Nurse Practioner and it is darn near impossible to see the DR. Our whole area has 2 PM.!

Dedra Farr

This article is useless! Chronic pain people are sent to pain management! They do not manage your pain as they are government controlled and are monitored and afraid of losing their license. My husband has had 3 back surgeries an each one only worsening his pain. Thanks to the opoid crisis and our state was #1 at one point, he cannot get enough medicine to have a life! His retirement is spent in bed most of the time.! We have no life thanks to PM! I don’t know what the answer is but something needs to be done for there are hundreds like him!

Thomas Wayne Kidd

I am just finding that the medicare payments are not as they were. Medicare is supposed to pay 80% leaving me will 20% , but this not what’s happening in my situation now at all. My next to last visit wad $160.00; Humana Medicare paid zero, after a write-off my part is $82.56; the last visit left me with $52.36.This look much like a play to get rid of me. My last visit the nurse practitioner asked how I was doing, I said I would be much better off if things were like they were prior to 2016. She goes into a rant and poof, a new diagnosis, ” medication fixation” I am very thankful that I receive as much as I do at the time. My wife is in daily chronic pain as well and has just began here Medicare but it’s useless because no doctor will even see her let alone treat her pain. We both have years of medical records but there to are useless. Medical proof is not the driving force anymore. Money and fear of loosing that money is the driving force, unfortunately. I am paying as much as possible in January and February in hopes that they will continue to mistreat me, in the capacity they now do. I haven’t had a PC in 14 – 15 years because I cannot afford one. My wife cannot even go to a doctor. Telling them this just brings blank uncaring stares. On they hang their heads and try not to look at me. I am so tired of this evil wickedness and can’t continue much longer. I to as one commenter said here will not stay calm when I am called a liar. And yes I downloaded the CDC Recommendations and had zero problem understanding them, and I was an eighth grade drop out. I actually continued to learning and educated myself. I will be 68 years old in July but my being an older sick person and disabled since 42 makes no difference to those who are supposed to be doctors. And I am not to blame that medical schools only teach about pain and it’s treatment for only 11 hours. This to is evil and sick. Thank you for trying to help, but I have heard all this before.

Judy Dunn

Thanks for the tips but unfortunately I live in Florida, the Primary Care Doctors
Outright refuse to give pain medication. The Pain Mgmt Clinics strictly abide by
(2) opioid pills per day. They take urine tests, you have to bring your prescription
Bottle with you so they can count the # of pills you have left. If you forget to bring
The bottle you don’t get your prescription. Yet they treat the real addicts like
Victims and bring them back repeatedly from their overdoses.

Our world is upside down, we are suppose to act like it is perfectly ok to be
Treated this way while the Doctors who are suppose to treat us and help us have
Failed us over and over again.

Terry

So all good advice and yes I get very anxious on appointment day but I have a question, for anyone. I read through the CDC guidelines and it says that exceptions can be made to prescribe more than the 90 mgs morphine equivalent, if warranted. So my question is, if my doctor prescribed more than the guidelines for me, the DEA could show up and take his license away. Why would ANY doctor take the chance? Maybe the guidelines should mention that if more meds are prescribed, there is NO chance of any physician losing their license. Maybe they could just be notified if their prescribing amounts are in question, and if their explanation is acceptable than nothing happens, if not then they (CDC), should suggest what is appropriate? Too many lives have been ruined by these guidelines and nobody wants to be responsible for any future overdoses. It’s all such a misunderstood problem. Keep emailing your government officials EVERY week, maybe somebody will help us take our lives back. God bless.

akbj

These are really helpful suggestions, thank you. A difficulty I have is that my appts at my pain clinic are between 5 and 10 minutes in length. That’s just not enough time for this kind of engagement. I’ve also had 5 different providers in the 18 months I’ve been going there so it’s been impossible to establish any continuity of care. (They retire, move, leave because they don’t agree with new clinic policies, etc.) Also, when I read the post appt notes in my pt portal they will frequently mention things that didn’t get said or referred to. Each new provider I see (At the same clinic) acts surprised when I mention anything at all it seems like. It’s just the same issues repeatedly & on paper the issues aren’t correct.
Prior to this clinic I’d seen the same provider for 10 years & she gave each patient at least 30 minute appointments! She was very unusual & unfortunately my bar was set pretty high. I was extremely fortunate to have had her as my provider.
Unfortunately the clinic I’m at now is pretty much into assembly line care.
Guess I am fortunate to be a pt at any clinic though.
Thank you again for your post.

Jennie Agard

I was amazed by the difference when I requested an appointment with my PCP for “pain management” instead of “medication follow up.”
It helps to know the jargon!

Hayden

I can do NOTHING but, “sing praises” to my pain management physician. I see the same doctor every time, he in fact “examines” my ability to move, takes my bp, visually tests motor skills etc. and then we talk. I was very fortunate to have been referred to this physician about 9 years ago. The first PM doctor I seen for 14 years, both expressly following “protocol”. This particular doctor never seems to be burnt out, tired of hearing the issues and goes to great lengths to actually listen and then suggest ….the alternatives. Never forces me to try another therapy mainly because in almost 25 years now, been there done that. NO effective alternative therapy, nor “medication” for severe pain management has presented itself. Maybe “something” will, maybe not. That is why with almost 25 years of pain management with prescribed MEDICATIONS and thorough documentation, it is lunacy for CDC to “suggest” as was published , the “guideline” for a maximum dosage of “morphine equivalent” for one and all. At 61 years old now, my record, documentation of the use of now damned opiate and synthetic opioids MEDICATION……speaks for itself. The enabling ability that the MEDICATION gave me at the proper dosage appears to be gone with the “guideline”. It has changed life so drastically, not for the better for myself and as far as I can determine, it is doing nothing to slow or stop unfortunate people from using illicit substances, with “some” prescribed MEDICATION found in an unfortunate overdose. Speaking for myself and I fully realize now that by FAR the majority of the prescribed patients in this country used our medication to ease pain, NOT to “get high” but, those not affected in simply living a day without feeling tortured, can not possibly comprehend this fact.

Gail Honadle

First you keep using the wrong terminology. IP is a disease on it’s own, it responds to no traditional treatment. It can kill through heart attacks, strokes, or suicide. There is NO cure. Intractable pain is typically considered to be a severe form of chronic pain. But unlike chronic pain from arthritic knees or similar cause, intractable pain isn’t easily treated or relieved.
https://www.healthline.com/health/intractable-pain It requires a Pain Medication. Not Snakeoil.

Your forms are as bad as those doctors hand us very small, for all the info requested. I provide a 2 sheet print out of Reactions with the Worst at the top to the least Hives at the bottom somehow the computer scrambles it, so a A fib reaction might end on the bottom. No one reads it anyway. Same for the current medicine list. As most Intractable Pain Patients I see more than 1 doctor. Whose computers even in the same system don’t talk to each other nor do you speak with my other doctors to form a treatment plan. Many medications don’t play well with each other. So it is important to read that medicine list. I’ve been handed samples, when checked say DO NOT GIVE TO THYROID PATIENTS. Which I happen to be, so you didn’t take the trouble to read my medical history at all, that could be dangerous. Why are the 2 C-sections I had in 1973 and 1982 important? The Cataract surgery I had 10 yrs ago might have some bearing but very little.

Being rude, I’ve had more RUDE DOCTORS & Physiotherapist than I am rude. Call me a liar and you will find out I can be rude and will FIRE YOU. I don’t discuss what the Neurologist or Gastro covers unless asked. If you are the PCP you get copies of ALL test, that is part of the problem, I see 4-5 doctors they need to coordinate a treatment plan so duplicate test don’t get run.

Cindy R

Another tip I learned that had been helpful is to start appointments with your regular doctor by telling them some good news – even if it’s just that you are continuing to walk a short distance daily.

In the book, “Sick and tired of being sick and tired”, the author points out doctors go into medicine to help people. Those of us with chronic conditions can be frustrating because we never really get well. Giving them something positive helps them stay motivated to help us. Also, as you said, always thank them for what they do to help!