Every month I visit my pain management doctor and every month I go through the same routine.
- Arrive and check in
- Wait between 2-3 hours to be seen.
When my name is called, I go to the back with one of the friendly nurses, who takes my blood pressure and weight and then asks: “What is your pain level like today?” This is when everything comes to a screeching halt and where I start sweating and my anxiety shoots from a 3 to about a 25. In reality, the worry begins first thing in the morning as I perform a general assessment of how I am feeling. Here is where the trouble lies, for me.
When I first began seeing my doctor, I thought it was going to be a place where they treated all of my pain. This was probably some naiveté on my part, expecting a kind of miracle cure. What I learned very quickly that first appointment, was that he would treat the pain like a triage, starting with what was worst. It’s been almost three years now, and he’s still treating just one part of the problem. I’m not sure if all pain doctors are the same, but I can see the logic in treating everything piecemeal. However, since my first appointment with him I’ve also learned about the fibromyalgia, rheumatoid arthritis and ankylosing spondylitis. With the advent of new diagnoses, I would think there would be different treatment offered, yet we’re still doing the same thing and my options are limited. Between random seizures that make driving unsafe and relying on family and friends to get me around, I need a doctor that is close. Let’s not forget the usual length of the appointments, which means they need to have a few hours to kill.
But back to the pain scale and my anxiety. As you can see from the pain scale (which was recently updated a few months ago) it’s very detailed. One of the more popular versions that I remember was the happy faces that gradually became sadder and sadder until they look miserable. This one is so detailed that even though I don’t have the pain scale in my face when they ask me, I have it in the back of my mind and all I can think of is what if my “7” sounds like I’m lying? What if they think I want more drugs? The very nature of the pain scale, in my opinion, is subjective. I’m the one experiencing the pain, not you, and so when presented with this scale it feels like you are trying to fit my pain into your version of what you think it should be. So, if I say I am at an “8”, and I am not panting out my words because of the pain, then what? I’m lying? Every time I go, this is the conversation I have in my head during the 20-minute car ride. But I don’t get truly stressed until I am sitting there and she asks me. It feels like a right or wrong answer to me and this couldn’t be further from that.
Pain is already a distressing factor in my daily life. I wake up with it, I do my daily chores with it, write with it, make supper with it, spend time with my family with it and go to sleep with it. Every facet of my daily life includes pain. I feel that chronic pain should be treated differently than emergency room type pain. What I mean is, you fell and broke your arm or you slipped on the stairs and twist your ankle. This is a different kind of pain that will go away once the problem is fixed. It might have a span of a few weeks until healed and then you go about your normal routine. Chronic pain is not like this. The most you can hope for is that it can be managed, which means that you are still in pain, but hopefully less so with medicine. An added irritation, is the focus on only one source of the pain, never asking me anything beyond that. I feel as though my doctor has this idea tucked into his brain, that if he solves the pain, he has been treating me for everything else will magically align itself and I won’t be in pain.
The pain scale is my nemesis. I’ve only been to the emergency room once for pain unassociated with migraine. Though, I will say, that in my experience, emergency room staff do not question migraine pain in the same way they do chronic pain. Which is why I’ve only been seen in the ER once for out-of-control pain, and even that was associated with surgery. I don’t think they have the same pain scale as above, but it doesn’t matter. I have it burned into my brain, so that I now question myself and the severity of my own pain, much more than I think I should. My pain is not the same as someone else with chronic pain and their pain is not like the next person with chronic pain, and so forth and so on. We each experience pain in a very intimate and personal way and I think that how we manage to express it to a doctor or nurse, should be honored, not de-constructed to fit within the confines of the pain scale.