Do Doctors and Pain Sufferers Agree on Pain Treatment Goals?

Do Doctors and Pain Sufferers Agree on Pain Treatment Goals?

By Staff

Pain sufferers look to reduce pain intensity and identify the cause of pain, while physicians look to improve function and reduce medication side effects, including dependency, demonstrating a marked disagreement on treatment goals.

This information comes from new research from U.C. Davis Health that was published in The Clinical Journal of Pain  The authors of the study recommend a pain-focused communication training for physicians.

“We wanted to understand why discussions about pain between patients and doctors are often contentious and unproductive,” said lead author Stephen Henry, assistant professor of internal medicine at UCDavis. “Primary care physicians treat the majority of patients with chronic pain, but they aren’t always equipped to establish clear, shared treatment goals with their patients.”

The following comes from a press release on the study.

The proposed training is especially important now, given recent state and federal guidelines recommending that doctors work collaboratively with patients on observable goals for pain treatment, Henry said. In light of the epidemic of opioid abuse and overdose, the guidelines also minimize reducing pain intensity as a primary treatment goal, creating new challenges for physicians when discussing pain treatment with patients.

“It is critical for doctors and patients to be on the same page and not working at cross purposes,” Henry said.

The research included 87 patients receiving opioid prescriptions for chronic musculoskeletal pain and 49 internal or family medicine physicians from two UC Davis Medical Center clinics in Sacramento, Calif. In most cases, patients were seeing their regular physicians. Patients receiving pain treatment as part of cancer or palliative care were excluded from the study.

Immediately following clinic visits between November 2014 and January 2016, the patients completed questionnaires to rate their experiences and rank their goals for pain management. The physicians independently completed questionnaires about the level of visit difficulty, along with their own rankings of goals for the patient’s pain management.

Nearly half (48 percent) of patients ranked reducing pain intensity as their top priority, followed by 22 percent who ranked diagnosing the reasons for their pain as most important. In contrast, physicians ranked improving function as the top priority for 41 percent of patients and reducing medication side effects as most important for 26 percent.

In addition, patients’ and physicians’ top priorities for pain management usually did not match. In 62 percent of visits, the physician’s first- and second-ranked treatment priorities did not include the patient’s top-ranked treatment priority.

Physicians also rated 41 percent of the patient visits as “difficult,” meaning the interactions were challenging or emotionally taxing. Primary care physicians typically rate 15 to 18 percent of patient visits as difficult.

One surprising outcome was that patients rated their doctors’ office experiences as fairly positive, even when clinicians did not. There also was no evidence that goal disagreements influenced patients’ experience ratings. This may reflect the fact that patients tend to have positive relationships with their regular physicians, even though they don’t always agree with them, according to Henry.

The researchers next want to identify best practices for patient-doctor communications that can be incorporated into training aimed at helping physicians better communicate with patients suffering from chronic pain.

“We need to make sure physicians have the medical skills it takes to effectively and safely treat pain, as well as the communications skills needed to discuss treatment goals and navigate instances when they don’t see eye-to-eye with patients,” Henry said.

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Authored by: Staff

There are 40 comments for this article
  1. Tim Mason at 4:08 pm

    The older person get the needed medication because it is a given that older people suffer and have much proof of pain causing organic disease, If you go into pain management and ask for a CII by name you are screwed. Let the doctor work up to that, It takes time and patience,

  2. Tim Mason at 4:02 pm

    I read that there is only 1 Certified Pain Management Doctor for every 1000 old chronic pain patients. You are right Mary. Where I live GP’s have not been writing CII medications since 2008.
    The best ones are found on your State Medical Board of physicians, Pain Management,
    Seek them out,

  3. Mary at 6:36 pm

    I feel so very blessed to have the most compassionate, listening, best doctor/patient relationship that I have as my pain management doctor for approximately three years now. He knows I want nothing to do with surgery and he has kept my pain completely under control. I might add that he is a “physiatric doctor,” which I don’t think too many people in our situation knows about. You should try to contact a doctor in this type field , as you might be surprised at how different they are regarding pain management treatment and “giving you a very good quality of life.” God bless to all that suffer so terribly from chronic pain and I truly don’t see an answer in sight. For numerous reasons I could lose my fabulous doctor tomorrow and honestly, I have no clue what I would do or to whom I would turn to.

  4. Judy at 3:18 pm

    I’ve come to believe that most doctors are totally CLUELESS!!!

  5. Donna J at 10:09 am

    The general public views alleviation of pain as a priority treatment goal, but doctors (and other medical personnel) do not. Their view of pain is as a clue to a mystery, or pieces of a puzzle; it indicates that there may be a problem, and where in the body that problem is located. Why would you want to treat pain, and hide your “clues”?

    Long term treatment of pain seems to indicate failure to doctors and is the realm of palliative and hospice care. Nothing left to diagnose, nothing left to treat, nothing left to cure. The clues are useless, the puzzle pieces won’t fit, and that leaves the doctor feeling frustrated, useless, and sometimes resentful of us chronic pain patients and our bodies which will not cooperate and get with the diagnose/treat/cure program of conventional medicine.

  6. connie at 11:06 am

    This will end the day a very small icecycle survives in a very hot spot! Our needs make it very easy to keep total control of us and once the government gains control of a group of people they don’t let go!

  7. Erin84 at 12:06 am

    I’ve been seeing the same PM doc for about 6 months for fibromyalgia, osteoarthritis, DDD, other neck & back problems, etc. Both the Dr & his PA lack basic compassion & bedside manner. In this 6 months, I was prescribed Tramadol (which is on my list of allergy meds, due to previous non-allergic reactions), compound creme & a TENS (neither of which scratch the surface of the pain), Lyrica that caused more harm than good & injections (which caused more pain than what I already have). They would have known what meds do & don’t work for me had they bothered to read the genetic testing report from my PCP, but they turned down making copies & adding it to my files on two occasions. They’ve asked me more than once what opioids have worked in the past, I tell them then nothing. I’ve passed their drug tests, jumped through their hoops, only to get treated like [edit] in return. The PA told me she wasn’t going to prescribe me anything & didn’t know what would help me with fibro because that wasn’t her “baby”. They fail to realize I’m not just a patient, but a paying customer. I don’t want much, other than respect & improved quality of life. I’m 33 & this isn’t living. I’m existing, cruising through time, missing out on so much in life. I’ve lost my ability to work, provide for my family, play with my kids, etc & am waiting on disability. I’m wondering if they’ve stopped to think just how many people are forced to stop working & apply for disability, simply because their meds were reduced or stopped entirely. The CDC should have at least come up with something for us before putting these guidelines in place & denying/ripping away our meds. I’m beyond tired of us, the many innocent, being punished for the actions of the guilty few. When does it end?!

  8. Tammy at 4:07 am

    I have been in severe pain I have degenerative disc disease. My last MRI on my C-Spine showed that I have anterior bulging between C5 and C7 with central canal narrowing and disc desiccation throughout now this is just the neck mind u I also have problems with thoracic stenosis and arthrosis or I assume that means arthritis. I have such severe pain between my shoulders it hurts to do simple things like just doing dishes. I’m not done I fail off a latter 4 yrs ago and really damaged my entire lumbar I’ve got disc bulging from my L2 through S1 canal narrowing pinched nerves from L2-L5 and I also have facet hypertrophy in L5-S1. Oh and I have an autoimmune disease RA. thats not everthing but my back is killng me. I was referred to pain mgt by my md and my neurogolist I got in w/no problem I chose pmgt as opposed to surgery but I have been treated so bad that I’m sure why they even have these type dr.s I get nothing to evenmy pain and the dr that I’m seeing is trying to make me come off of meds that I’ve been on for ten yrs and this was against the advice of my phsyciatrist. which sent him a letter stating this a letter that my pgmt dr requested but now he says he won’t prescribe and any kind of opiate until I come off the other medication I’m confused in his office there a sign that has I pledge to my patients to do them know harm. well my quality of life sucks thats I want to be able to do the things I use to do without being in so much pain I really need help and I’m not some drug addict I just want some relief.

  9. gerard l becker at 8:44 pm

    at least, I know I am notttttttttttt alone in my beliefs!
    If I could only inhabit the virtual city of chronic pain on the internet!
    orrrrrrrrrrr is the world of the non -pain person surreal!?????????????
    makes one think, doesn’t it? , isolated in real time, yet surrounded by millions of kindred spirits who are incommunicad0!!!!!!!!!!!!

  10. Tim Mason at 7:53 pm

    Chiropractic visits helped me too 50 years ago when I had a misaligned lumbar vertebra I got from doing masonry work. Of course this was not really chronic pain just an unresolved alignment problem. Later, I figured out I could have fixed this myself my laying on a tennis ball and rotating on it until the vertebra popped back into place.
    Long term chiropractic visits have been shown to cause irritation and god forbid you let them adjust your neck.
    Different stroke for different folks. I have to presume that if chiropractic visits work for you, you may not be in a diseased state or are very young.

  11. Tim Mason at 7:28 pm

    Hi Judith, I assume this is for radiculopathy – pain. If they gave you a CD to look at or any paperwork READ THE FINE PRINT. You may need a magnifying glass. Ask your doctor what his infection rate is. This is a valid question and he/she should not take office to it.
    How did the trial go? Did it work? Is it the low frequency or high frequency device?
    Can you use it while driving or do you have to turn it off and drive to the grocery store in pain?
    You could go the FDA website and look up medical device recalls. I would search by the brand they are selling you.
    I am 59 and really not a risk for drug addiction and you certainly are not a risk for addiction nor a problem for long term opioid use.
    So my question would be why not increase your medication or change to something like a fentanyl patch and oxymorphone for breakthrough pain?

    Tim Mason 59, OA, DDD, spinal stenosis, facet arthrosis, post lumbar fusion (ALIF 360)
    Be well.

  12. Tim Mason at 6:53 pm

    Bob, I have almost identical problems. I do have a question about your doctor that wants you off you medications.
    1. Is he/she 35 or younger?
    2. Is the an MD or a DO?
    3 How long has this doctor been practicing medicine?
    Do a through search by googling Doctors full name and the word vitals. Do the same type of search the doctors name using the word health grade.
    Next, do this. I will use my state as an example
    State of Tennessee Office of Investigations for Health Related Boards.
    Use your state, here you will find any official complaints about a doctor, PA, NP, surgeon in your state. This site will also allow you to file a formal complaint using you doctors license ID # found on any of your prescriptions. You can also list a witness for any maltreatment during your visit(s)
    Good Luck

  13. Judy at 8:39 am

    As a 25 year chronic pain sufferer,(DDD being the main cause of pain), my doctor decided 20 years ago, that I just needed to “learn to live with the pain”…..which meant pain medication was reduced to a non-refillable prescription of 20 pills to last about 6 months. After a few years, it was basically no meds unless I had a flare-up of sciatica, which usually happens once or twice a year.. I’ve learned to live with the pain at a level 7-8 on a good day…..but the quality of life is gone. I can’t do much of anything I used to do. I don’t cook, or clean, or even take a shower often. A 5 minute car ride to the grocery store is excruciating. What the medical community doesn’t seem to realize is that there’s NO CURE for chronic pain, they want to “fix you”, but there is treatment that takes the edge off our pain so that we can at least FUNCTION….that treatment being pain medications. I have no faith in, and no respect for modern medicine that just refuses to listen to our complaints. I’ve also done the physical therapy, the chiropractic treatment, the pain management doctors who think an injection will fix everything….it doesn’t. And for me personally, surgery wasn’t an option. I’ve heard to many stories of failed back surgeries (my younger brother had 3 back surgeries & he’s worse off today than before the surgeries). I’ve also heard a lot of negatives about the spinal cord stimulator they implant in you…most people eventually have it removed because it doesn’t work for them.Somewhere in the middle of these last 25 years, I became very depressed (who wouldn’t be?) and was put on anti-depressants. Once I went off anti-depressants, I was just disappointed, disillusioned, and MAD AS HELL at the lack of good medical care. I also became extremely fatigued, although never officially diagnosed with Chronic Fatigue, I’m reasonably sure I have it. I wake up every morning as tired as I was when I went to bed the night before. I have little to no energy all day long….by 1-2 o’clock in the afternoon, I feel like I hit a brick wall. I would love to have a life worth living, but I’m too exhausted & in too much pain to care much these days. Death will be a blessing….but I’m not really in a hurry to get there. I wonder if doctors remember “First do no harm”???

  14. Tim Mason at 6:01 am

    I have read the entire guidelines more than once. They do not prohibit prescribing narcotics for pain and in fact encourage their use for non cancer pain and even list them as usable for acute pain for short duration.
    The statistics some groups use are flawed. They mention their has been an 20 % increase in prescribing opioids in the last 10 years. They fail to mention that the age group that experiences the most pain has increased exactly 20%.
    Sick people die everyday. Many sick people have pain and are on opioids. This is not accounted for in the statistics for the autopsy. Opioid overdose trumps crippling arthritis on the coroners report.
    People are ALWAYS going to DO drugs. There are the occasional < 25 that stole granny's or momma's medication and washed it down with some "purple Jesus" on a Friday night and never wake up.
    That's not my fault. It is momma, granny and the immature youths fault.
    If you want to stop the diversion of narcotics go after the Cartels and Wall Street suppliers not doctors and old people.

  15. A Reed at 8:57 pm

    In addition to my previous comments, I also want to let everyone with spine issues know that any manipulation of the spine could cause something known as arachnoiditis. To put it simply arachnoiditis is an inflammation of the membranes that act as sheaths and covers and protects the spine. This inflammation of the membranes could then in turn cause cauda equina syndrome and a multitude of other life changing medical problems. I do want to make it very clear though that any manipulation of the spine does not ALWAYS lead to arachnoiditis. At the present time there is not a clear-cut cause of arachnoiditis, but as I indicated previously manipulation of the spine could cause it. Also the medical profession is now starting to realize that the injections of steroids and lidocaine and other similar drugs into the area close to the spine could very well be the cause of arachnoiditis. I believe that these injections are great money makers for some Dr’s and to be fair have in the past been used in an effort to relieve back pain. Arachnoiditis has been up until recently considered an orphan disease, but at this time I believe they are starting to realize that it’s more common than previously thought.

  16. A Reed at 8:07 pm

    I agree with AC Burke. I feel that if the patient’s pain intensity is treated, then the patient will be able to meet the doctors expectation which is being functional. I really don’t understand how no one can grasp the fact that pain intensity directly relates to functionality. If you hurt, it’s going to be a lot harder to wash dishes and clean the house. I also don’t understand only treating pain in the cancer patients and in palliative care situations. Anyone who has disease, or any health/physical issue that causes pain, I believe deserves to be treated for their pain.

    I have arachnoiditis, RA, lymphedema, degenerative disc disease, osteoarthritis, etc.. One of the things that puzzles me is that when I was in another state they had no problem writing down my diagnosis as being arachnoiditis, but in the state I’m presently living in my Dr is not writing down arachnoiditis as being my diagnosis. I don’t understand. I also can’t comprehend the fact that the Pain Management/ Specialty Care section where I currently see my pain management team at have indicated that they are trying to get ALL of their patients at a standard dose of controlled substances or less. This one-size-fits-all mentality bothers me and confuses me as I don’t believe everybody is going to be able to all take the same dose and have it be effective for their pain.

  17. connie at 7:39 pm

    Chiropractic does works very well for SOME chronic pain but as with every other type of treatment. There is no single answer that works for everyone because there are so many different causes of chronic pain and even with the same diagnosis people react individually to pain and treatment. Please as a pain patient don’t make blanket statements about whatdoes or doesn’t work for treatment!

  18. KC at 3:58 pm

    I cannot say more then what has been posted already. I suffer from. A c6-7 fusion. It helped but now I am is more Pain From neurological musculoskeletal pain and I want to die most days. I am involved with a hospital based pain clinic which has made it worse by removing all pain meds. It’s been 7 months with no help. They think physiotherapy, and psychology will fix it. NO IT DOESNT. I’m in bed every moment after therapy and I can’t get help from my gp as he won’t stop on my specialists toes. He used to be the best help. I am not an addict clearly but I could work when I had pain meds. I can not now. And this is why we have illegal drug sales. People like me search for pain meds to survive each day. I can not afford to buy illegal drugs so I suffer every day.

  19. James brown at 3:23 pm

    Pain management and treating the cause should be the goal of treatment. I have had two hip replacements at two different hospitals. One hospital left me in intense pain after surgery. The other managed my pain and I did not suffer. Two different Doctors and two different hospitals. Go figure. When pain is real and acute…it should be treated.

  20. Judith Pennell at 1:35 pm

    I would like your comments if you or someone you know has dealt with a spinal cord stimulator. I am scheduled to have the SCS implant on March 28th. The closer the date gets the more anxious I get. I just can’t get over the fear of having a foreign object in my body even though I am pretty much in high-level pain even on 10 milligram oxycodone 3 times a day. I am pretty much a couch potato and have no .energy and at 74 years old I know especially with the current laws making the medical practice scared of having a lawsuit against them for prescribing opiates for documented pain. The decision is still weighing heavily on my mind. If you have any comments good or bad please respond

  21. Don't matter at 10:07 am

    I’ve been in pain since I was 20 and my dr kept telling me that I will need the pain medication more when I’m older now over 50 and they took all my pain medication away
    I wish every dr could feel the pain the way I have pain and then take their pain medication away it’s not fair I know life isn’t fair but come on the world I can’t live without them no one wants to prescribe pain medication
    I guess my time is up
    Very disappointed with my old doctor of 30 years

  22. Arthur Feintuch at 9:53 am

    Chiropractic has been proved to be the most effective treatment for chronic pain

  23. Tim Mason at 4:17 am

    Kim, doctors know “about” pain. Few under 40years experience chronic severe pain. Pain being subjective they don’t know.
    It like someone said. “If you want to know what it feels like to be dead, ask an embalmer, he works at a funeral home.
    Tim Mason 59, DDD, OA, Spinal stenosis. post lumbar fusion, post total hip replacement.

  24. Tim Mason at 3:58 am

    Joann my guess would be that the elderly person would eventually reach out to an Emergency Room for help. 9/10 days that I get up I feel like I have been hit by a car. (I actually was when I was about 13 years old.)
    As far as not being treated, fill out the complaint form to your state medical board and put his or her license # on it.
    It is actually a form of ‘Elder Abuse” in my opinion.

  25. Bruce Stewart at 1:15 am

    “In light of the epidemic of opioid abuse and overdose, the guidelines also MINIMIZE REDUCING PAIN INTENSITY AS A PRIMARY TREATMENT GOAL, creating new challenges for physicians when discussing pain treatment with patients.”

    What is this, some kind of joke cooked up by someone who’s never been in pain?

  26. Bob at 1:08 am

    Back in 2001 I suffered a severe injury to my cervical spine, encompassing my C-5 thru C-7. The first neurosurgeon I visited wanted to use the latest and greatest birdcage type fusion. At the time another surgeon advised me against it, stating “Once you do this, there’s no taking it back” (No pun intended). Thank God I waited because 2 years later there was a recall on this particular manufacturer.

    About 8 years ago, the Doctor I was seeing sent me to what he called “The best neurosurgeon in the state”. After he studied my recent MRI, he told me that any procedure he did would not alleviate my pain. He also sent a letter detailing his evaluation to my doctor. During my next visit, my GP told me to march back into the surgeons office and demand he do the procedure. I of course was dumb enough to question the logic behind it. Because of my noncompliance, he ejected me from his office on a Friday afternoon without giving me a refill of my pain medication. Talk about panic!

    Thank God I was able to contact my previous Doctor who had moved 150 miles away who immediately told me to get my behind down to her office. She was the best, most compassionate Doctor I have ever had in my life. I continued to she her until she past away.

    I suffer from the original injury, but now it includes DDD, spinal stenosis, severe narrowing of both my left and right femoral and osteofites. My current Doctor tells me that most of this is in my head regardless of my mile high medical records and countless MRI’s and CT scans. He tells me that once he takes me off my pain medication, I will feel much better.

    In my humble opinion, there seems to be a lack of compassion from some Doctors in today’s environment.

  27. Spiritdog at 12:54 am

    I just dont get it. This country so dam worried about opiod abuse im so sick of feeling like im labeled a “drug addict” i went many yrs ago from drs screwing my insides up after 6 surgeries and then had to have only way a vaginal hysteroctomy cause im so filled with scar tissue its painful all my organs are moved in different places i have constant pain narrowing of the bowl and from over 6 mo in hospital 2 times clinically dead. To then go to pain mgmt then have an ex who best [edit] out of me. That he definetly did all damage to neck and back as rheumatoid arthris fibromyalsia.. My knees are shot.. I had my nose broken twice i leak clear fluid from my nose its crooked eabt that ficed too not my nose changed. I like my nose. I had brain tumor in 04 suppose to be tested ever year lol. I cant afford and since bk when i b4 exConstant swollen lymph node i dont want to lnow.. But agreed to stsrt with easy tests.. Need glasses need dentist bad had petfect teeth just 6 yrs ago. I do same routine as aleays did. Well nobody told me what was the worst that would happen being on pain meds. we have so many up and down spine herniated and bulging leaking discs from the neck to my mu lower back. I was taken off more than half of meds for pain i already suffer from anciety and severe panic atticks asthma i have an EST dog and servicr dog also do you know how bad my anxiety is depression i went to living a somewhat quality of life able to go places and do things to now be bed ridden. Some life. As you can see im up all night.. And im just at a point is it worth it. I know there many others i read i don’t see all but mostly seem all same and its not fair. I do not get high from my pain meds it takes away ost not all at all by far i wouldnt day most b4 they did this taking all off some i heard did have to.. But even my dr said one time i was in so much pain in office i asked doc why dont i feel anything. You know days like this would be nice if i felt well a little stoned. To feel nothing but good. I havent felt that now in over 30yrs. And im not that old. He told me if you feel like that then your on too high a dose or just dont need it. He said im glad to hear that its doing something for your pain.. But I didnt want to go any higher or more kinds or try pills other than i had used. I can laugh at what im taking. I finally in my mid to older years get to live fown the shore. I eas so looking forward to the beach and ocean “walking” Taking hikes..i can kiss that dream away. I also have alot more wrong nothing that i know of yet going thru testing. But so far no cancer. It wiped my family away aints and uncles my brother died of herionne overdose my best friend he was a casual user had great job i never new about he told me everything. He just got a bad shot. I wouldnt think of ever trying anything like that. My father was a retired 37yrs on pilice force retired as acting chief and detective captain over all. Now a daughter i never been in any trouble. NOT EVEN A SPEEDING TICKET. So why does the DEA HAVE TO MESS WITH THE OBRS EHO NERD FOR A AUSLITY KIND OF LIFE TO LIVE. CAUSE I KNOW IM GOING TO GET WORSE AND ID RATHER TAKE WHEN DAY COMES THE SHORT CUT. THANKS SO MUCH THE GOVERNMENT AND DEA /FBI SCREW YOU! Have a dam heart. And do your homeork on picking out people too. See if you have cancer you have no problem. Nice im glad they didnt hurt them but what are we??I DIDN’T ASK TO BE DISABLED I LOVED MY JOB. I CAN’T EVEN MAKE RENT THANKS TO SSI. !! How do you feel or would you feel being in my position like all the others. ????

  28. Amanda Albany at 10:21 pm

    What is a patient who will suffer a lifetime of pain to do? I want to be as active as possible, yet everything I do causes more pain…meds help me move, lack of them means I’m stuck in bed…yet my doctor seems to think that’s what I need since there’s all this stigma of prescribing what the patient needs vs being worried they’ll get in trouble if they prescribe what some might think is too much…but how is my being stuck in bed to manage pain on less meds helping me live my best life, when I know that I could do more if I could just get the pain relief I need to function and do for me and my family…I’m not paralyzed, I should not have to live in bed at 30 something because of pain!

  29. Tim Mason at 7:05 pm

    In most every instance you see the MD once. The Doctor does not usually do subsequent appointments as they are done by his PA, NP or other designate. .Only when the patient has a different opinion about his treatment does he/she get to see the doctor again. I have had to do this twice. It was my refusal to do a spinal cord stimulator trial. I handed the NP an article showing how the SCS is a growing business and marketing is aggressive.
    People don’t realize that once you get one of these implanted you now see a representative of the manufacturer not a doctor. It is no longer the doctors nor the NP’s problem but that of the representative.
    I overheard conversations with the scheduler with patients calling in complaints about infections and sores at the electrode site, Next call, over stimulation, won’t charge. etc.
    Most people wait for the battery go dead and never recharge it. Finally the devise is explanted.
    I could not make an informed consent to have something implanted which removed the DOCTOR from the patients problems.

  30. Dooney at 6:46 pm

    Maybe functionally can be improved once you get the pain to an acceptable level !. I remember my pain doc wanting me to do yoga among many things. I can’t have 8/10 pain and do downward dog, I can barely get off couch. Now that my pain is better I can participate in many things I couldn’t before.

  31. Candice Hawkins at 5:05 pm

    I was at the pain facility in our area to take my 30 yr old son who suffers from chronic foot pain due to infant corrective surgery for rocker bottom feet that eventually developed into severe osteoarthritis. I’m an old hand at chronic pain as I have suffered pain from failed back surgery for 25 years so really nothing surprises me anymore except for what I experienced. An elderly gentleman was sitting in his seat, very agitated and discussing an issue agressively with the office personnel. I have a propensity to eavesdrop since I am an RN and pain sufferer.
    The man was upset over the paperwork, the fact that his Medicaid wouldnt pay and as I believe the office persons inability to present one iota of understanding. She walked off and the man, in his early 80s, was almost in tears.
    I schooched over in a seat next to him and offered to help. He had no idea why is family doctor would no longer treat his 40 years of chemo neuropathic foot pain.
    In 15 minutes I tried to explain what the govt had done and apologized for the medical professions ability to smooth the way for our elderly in pain. The first 5 pages of the paperwork he was to fill out was illegible due to the letters running together so I read him the questions that were made up to ascertain how a patient dealt with the handling of the opioids he received which is used by the doctors to see if a new patient is hoarding drugs, selling drugs, depressed over not having enough and so on. You can only imagine how confused this gentleman was over why anyone woukd think he would do these things.
    Even though there is motive to the madness of the medical world I have to say that I cited at least 5 things that were handled so inappropriately when dealing with this patient that it made me furious.
    How dare that office woman humiliate this man in front of an entire room of patients by stating, “You have to pay or you don’t see the doctor.”
    Then, “I’m sorry you can’t read these pages but you don’t get in if you don’t fill it out.”
    When I had to follow my son in I told the elderly man to try and fill out the rest then tell the PA what happened.
    When my son and I finally saw the doctor I told him how appalled I was over the treatment of a man who served in WWII and who was in chronic neuropathic pain.
    Shame shame shame on his office personnel. He was appalled but I’m sure the procedure was not changed or the office woman was not chastised.
    As a nurse I’m ashamed of what the govt has done in belittling pain patients into thinking they are guilty of drug use before they even see a doctor.

  32. James Crow at 3:29 pm

    I have broken my back in a car wreck and twenty-one years later fractured several bones in my back an pelvic region falling down a set of stairs. Over the last twenty plus years I’ve jumped through every hoop I can think of, a l5 back fusion which made the pain worse. While X-rays said it was a great operation. Most Dr’s have treated me with a great deal of skepticism. In the later 90’s up to 2012 after a lot of hard work I did find Dr’s who would work with me on conservative and opioid treatment. This was the only thing way I could continue to work. In 2013 my job ended. I moved to Portland Oregon where unfortunately I had to start over with new Dr’s. My latest MRI. show my disc. above my fusion has herniated, but all fairness about thirty percent of most people experience this many without pain. Last three years my current Dr. Is forced to go through a committee review in order to continue any type of opioid treatment I’ve agreed to take pain management classes, physical therapy, acupuncture join LA Fitness, take yoga twice a week. These are all great things if you are suffering chronic pain. But with out the proper treatment of opioid, Lyrica, napoxin, things become to painful. I’ve had to retire early on disability and a small allowance from the government. To which I’m grateful for.
    My Dr. told me this week their clinic would no longer treat any patient with any type of opioid for any type of chronic pain. It took me three years working with my current Dr. to get my current treatment regime. I said I would look for a pain management specialist. To which my Dr. Laughed “good luck with that!” “This is the people’s Republic of Oregon. “

  33. Bob Schubring at 12:48 pm

    This communications failure commences in adolescence, when the ideation first develops that the child could apply himself or herself to their studies and have a career in medicine. Almost at once, the child picks up subtle cues, that the physician has an entitled position in our culture, and this attitude is reinforced throughout the college years and is habitual by the time formal medical training commences.

    After four years of medical school followed by residency, Listening Dysfunction affects many physicians.

    Characteristic of Listening Dysfunction is the ideation that the patient’s words are undeserving of serious consideration. The physician with Listening Dysfunction, selectively listens to the words coming from the patient, occasionally agreeing with those few words uttered by the patient, that appear to concur with the clinical impression and preliminary diagnosis, and ignoring the majority of what the patient attempts to say, usually cutting short any effort by the patient to ask questions about diagnosis, prognosis, and self-help to adapt to their ailment or condition.

    Early-stage Listening Dysfunction makes physician-patient interactions problematic. A hallmark of Early-stage Listening Dysfunction is that the physician labels patients as “difficult” and “uncooperative”. Over time, an increasing percentage of patients gain this label of “difficult” or “uncooperative”.

    Mid-stage Listening Dysfunction manifests itself, when the avoidance of “difficult” people extends beyond the physician’s practice, and begins affecting interaction between the physician and non-patients. Often the physician with mid-stage Listening Dysfunction complains that their colleagues, supervisors, spouses, children, legal counsel, and public officials who regulate their practice, are “difficult” or “uncooperative”. The physician expresses disappointment with their career choice of working in medicine or surgery. Many self-identify as experiencing “Burnout”, attributing their dissatisfaction to an excessive number of hours worked, inadequate recreation, poor diet, or lack of companionship. Divorces often occur at this stage.

    End-stage Listening Dysfunction presents as clinical psychosis, usually in the form of clinical depression, perhaps with other complications. There may have been an episode of substance abuse. There may have been a botched attempt at suicide that has put the physician into an emergency center as a patient, often under arrest and involuntary commitment, if he or she did not voluntarily sign into the hospital for treatment of a mental condition.

    A danger of mental illness in trained medical professionals, is that these patients know better than most, how to harm themselves swiftly and irreversibly. Where their medical education failed them, is that it did not teach them to recognize when they were overwhelmed and how to seek help from colleagues. Essentially, they entered medical school with a cultural bias, believing themselves to be invincible, more intelligent than their peers, and to have better judgment than anybody else. In their professional education, this bias was left undisturbed. Once in practice, they blamed failure upon everyone else, taking no share in it, and isolated themselves socially, in so doing. When failure became overwhelming, the cultural bias they learned, believing themselves to have superior knowledge and judgment to anyone else in society, gave them no one to whom to reach out and seek help. They burn out and suffer alone, because they sincerely believe there is no one else to ask for help. It is this sense of isolation and finality, that leads to the suicidal ideation that claims their lives.

    Tearing down this edifice of mental walls should commence in the first year of medical school, if not sooner. It is a waste of time and money to send people to medical school who are going to kill themselves and take their training with them to the grave. Clearly, if taxpayers are to finance the operations of medical schools, it is in our interest to take preventive measures for Listening Dysfunction.

    Effective communication skills for the physician, begin with recognizing that the patient actually lives inside his or her body and has vastly more experience with it, than does the physician, who necessarily is playing catch-up, after the patient presents with complaints seeking treatment. The patient-physician relationship is not a command-and-control one, like a sergeant would have with a squad of soldiers. The patient and physician are exchanging information and effort in a web of trade. The patient has deep experience dealing with the disease condition that has flared up, and also has knowledge of any other chronic ailment or genetic limitation that has presented itself in the past, as to how it feels to live with it and what may have happened the last few times it flared up. The physician has deep familiarity with a large body of scientific knowledge, is not under the emotional distress of having the patient’s illness and thus has more stamina than does the patient, and can furnish helpful information to the patient in arriving at a treatment plan. Moving beyond information into effort, some entity pays the physician money to work full-time in the clinical setting, providing this service to patients. Those patients who are in their earning years, somehow provide money to the funding entity, either via taxes, insurance premiums, or direct payments. Elderly patients usually provided such payments during their working lives and have a legal claim to receive benefits, in exchange for those past payments. Children generally receive benefits funded by their working parents somehow. Confusion about the role of the funding entity, about what the patient did to earn the expenditure of effort toward his or her care, or about whether the patient’s lifestyle or future income will be adversely affected by both the illness and by the treatment, erode trust between physician and patient. Understanding these financial issues and explaining them forthrightly, is essential to adequate communication in other areas relating to the patient’s recovery. Equally important, is that the patient understand that his or her recovery will require personal effort at following the treatment plan. That effort cannot be paid for, and done by proxy. The patient lives inside his or her body, and whatever must be done from inside the body, the patient must do. Complying with diet, medication, or exercise plans, cannot be anyone else’s responsibility, because it is the patient who must swallow the food and meds, and move the muscles to do the exercises.

    Recognizing that doctor and patient do have a relationship, gives both parties a reason to put some effort into communicating effectively. This must be encouraged.

    The adding-on of multiple and redundant layers of bureaucracy, tasked with giving doctors excuses to spend less and less time and effort on patient interaction, is troubling. It provides those physicians with Listening Dysfunction, a range of excuses not to listen, to obsess over their unrecognized self-importance, and to blame patients for their own ailments rather than provide patients with relief. Institutional medicine and the funding entities that gobble up money micromanaging the small amount the entities deem to share with physicians, are encouraging dysfunctional medicine and discouraging effective patient care.

    Less than a century ago, dysfunctional medicine was a rarity. Patients controlled the payment of money to most caregivers, and only the poorest of the poor who needed healthcare done for them as a charitable gift because they had no means of paying anything for it, were powerless over how the physician was to be paid.

    Today, most physicians earn less than they did. Bureaucracies that ration care, abound. Costs continue increasing, because the care-rationers demand to be paid increasing amounts of money, in parity with their delusions of self-importance. (Some of those care-rationers are themselves burnt-out physicians who are in mid-stage Listening Dysfunction). Patient care is diminishing in quality. Pain patients are at Ground Zero in the fight, because we are easy targets. We don’t move well and we tire quickly. But it’s up to us to speak out effectively.

  34. Alisha Renken at 12:45 pm

    I’m just not sure exactly what a chronic pain patient should do to control their pain when they have tried chiropractors ,exercise, physical therapy and all the doctors know that I have tried this but I chose not to have shots in my back or my hips and opted to instead of control the pain with medication and try to exercise.

  35. Joann Contreras at 12:35 pm

    How do PCP physicians make a decisions when treating a patient for years on opoids ,then being sent to pain management & the older the person gets, the more sets in like arthritis, knees, shoulders, Diabetes ,Fibromyalsia, back, neck disc problems, then PAIN
    DOCTORS want to reduce medications.Injections, everywhere,NO RELEIF, ALWAYS IN PAIN, now what???

  36. Kim at 12:13 pm

    Docs and Patients need a trust relationsjip, common goals and common languafe. Very hard to find… i think docs would b more successful if they had a chro n ic pain person on staff to help ensure efficacy and accuracy of communications..someone who has lived with chron8c pain and had to struggle to deal with docs for care..a translator or bridge of sorts..

  37. AC Burke at 11:34 am

    Reducing the intensity of pain is the best way to improve functionality. If your pain level is not at a manageable level, you won’t be able to participate in, and endure the rigors of physical therapy. Once a patient feels in control of their pain with the partnership of a caring physician, chronic pain patients are usually eager to explore the cause of their pain and use the recommended treatments that will lead to a better long term prognosis.

  38. Tim Mason at 11:05 am

    Mine looked at my MRI and gave me two years to keep walking. He’s taking care of me on my medication but said scar tissue is encasing the L5 nerve roots and L4 disc is extruded. You have spinal stenosis and will be in a wheelchair in 2 years. I went back to the surgeon that did by fusion and he said the same thing and if I remove that piece of disc your entire spine will start to collapse. I got worse and went back and saw the surgeons PA.(an under 30 millennial) She said you are just an old man, not going to get any better, here is a prescription for a cane and some valium.
    Don’t know where to turn.
    Tim Mason 59 DDD, OA Spinal stenosis

  39. jess at 8:42 am

    Doctors do not treat or even take on chronic pain patients anylonger so this artical is a mute point now. Doctors only care about themselves and cash not the harm they contribute to. Worthless egomaniacal [edit] all of them.

  40. StevefromMA at 6:50 am

    I sure didn’t rate my experience with pain management positive. As noted, they talked functionality and ignoring the pain, easy to say when you’re in a nice chair in a white coat in a medical office.