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#HAchat Recap: The Invisible Epidemic: Pam Ressler Talks Pain
by Caitlin
130 million people in the US are chronically ill, and 116 million of these people suffer from chronic pain. With so many suffering, it’s amazing that chronic pain is something rarely talked about and a constant source of tension between those who suffer from pain and their healthcare providers (HCP). Why don’t people talk about chronic pain? Why is there stigma against those who suffer from chronic pain? As HealClick pointed out, no one has ever questioned the “stomach ache”, so how can HCPs doubt “unbearable pain”?
This week’s chat was hosted by Pam Ressler (pamressler), a current faculty member of the Pain Research, Education, and Policy (PREP) program at Tufts University, registered nurse, social media enthusiast and pain research advocate. Wendy Williams (TuftsPREPpain), Associate director of the Tufts Prep program also joined in on the conversation.Perceptions of Pain
pamressler: Huge problem…pain is invisible! It’s not something you can put under a microscope or cover with a bandage, and this is the biggest reason it’s so hard for physicians and HCPs to understand, it’s something that they can’t exactly put their finger on. Many doctors seem to be under the impression that chronically ill patients “just want to swim in opiates” as TiffanyAndLupus put it, and they label these chronically ill patients as drug-seeking. They are also hesitant to treat pain because they don’t want to get labeled as “dealers” of pain medication. Then it’s the fact that there are different types of pain. julianna12369: “There seems to be a breakdown when it comes to visits to hcp’s for chronic vs acute pain.” Co-morbidities can also stay a doctor’s hand when writing a prescription: julianna12369: “There is a lot of stigma. As soon as someone sees I am #bipolar and I have #lupus, that’s it for taking much of my pain seriously.” In this way, suffering from multiple conditions may undermine a patient’s “pain credibility” with their doctor.
ArthritisAshley #HAchat I have anxiety & rheum arthritis, chiari, celiac, palindromic rheumatism, DIL, POTS, thyroid issues but anxiety is all many docs see -#HAchatAnd even if you find a doctor who understands your pain, ER trips can lead to accusations of drug seeking behavior. In the end pain has a bad reputation amongst both patients and caregivers. For patients, it’s a life altering inconvenience. For HCPs: ArthritisAshley: “I hate that chronic pain disorders are associated with hypochondrism, pill-popping etc.”
hockeygrl1: i wish my dr would listen more. She attributes pain to #frbro & gives me antidepressants, sometimes i need more #hachat
kimmieCollas @hockeygrl1 & some of us can’t TAKE antidepressants (manic episodes & other nasty effects #HAchat
But it’s not just about the pain. It’s about how others perceive your pain and how you perceive yourself. It’s one thing to not have your doctor believe in the severity of your pain, but what if members of your own family were in doubt? hockeygrl1 “I agree on the family worried about pain medications. My daughter mentioned that she thought I refilled mine too soon. not true”. What about all of the things that result from chronic pain, such as fatigue or depression? How do you treat these symptoms without throwing anti-depressants at the problem? Susanmees: “docs need to ask what else is happening in someones life, not just physical pain, mental &stress issues too”.
Thinking outside the doctor’s office
The chromatically ill and those suffering from chronic pain seem to be some of the biggest advocates of alternative therapies, even when doctors are not: kimmieCollas “most of the MDs I’ve talked to abt integrative therapies say there’s no proof – I say if it helps, I don’t care if there’s proof .” Here are some therapies our Health Activists have tried:
@pamressler: We need to expand our tool box for chronic pain…meditation, yoga, tai chi all can play a role #hachat
@FabulousandSick: I totally agree. We also need to add diet changes to our tool box.. #HAchat
TiffanyAndLupus T1: This month I have been learning meditation and taking a chronic pain yoga class. BOTH are helping to relieve my pain! #HAchat -
bitogoth Finally started meeting with a therapist to address anxiety/stress aggravating chronic pain, and nice versa #HAchat
PainCHAS massage therapy is smart conservative solution. also should not forget about psychology
bitogoth Heat, hydro and electrotherapy all help for me, but not always accessible (hydro) #HAchat -
Writing your own pain scale
Just as different therapies work for different people, pain is different for everyone. We often talk about how each patient is unique and that no one deals with their condition in the same way, reacts to medication the same way, or has the same needs in terms of their treatment or care. The same goes for pain, which is another reason pain is so hard for doctors to treat. julianna12369 “I would like pain scale thrown out. I want my hcp to know that years in pain make my 5 diff then that 5″. But how is a doctor supposed to treat that? How does he or she know that your 5 is worse than someone else’s? ArthritisAshley “My pain & symptoms are always in flux. I could be fine one minute & immobilized the next”.
bitogoth suggested defining your own pain scale: “I wrote my own scale for my doc- very specific. Has helped much in communicating pain”. It will lead to a better conversation with your doctor about your pain, and also help your doctor decide on the best course of treatment. You should also define your expectations with your doctor. While it’s important to strive for a pain-free life, it seems that most of our Health Activists found this to be unrealistic: julianna12369 “I don’t expect to have ZERO pain, I think that’s unrealistic. Healthy people have SOME pain. Just manage pain.” As always, communicate your needs to your doctor and come up with a plan to address them. Like patients in any other condition, the chronically ill and those suffering from pain are just expecting for their doctor to listen and respect them: julianna12369: “so my expectation of my HCP is to listen, believe, communicate, and try. And for me as a patient, the same.” TiffanyAndLupus “I would like my Drs to know I am coming to them for help; because I don’t have answers.”
Finally two pieces of wisdom to carry you through the week. Last week we heard from an HCP that doctors hear empowered groups more than empowered individuals, so don’t forget: TiffanyAndLupus Alone we are one; together we are strong. @HealClick: 130 million total chronically ill… The epidemic no one knows about.
And though we doubt you need a reminder of why it’s important to talk to your doctor about your pain: ArthritisAshley – “I had a doctor tell me it was “all in my head.” It was but NOT how he meant it – I had Chiari malformation & needed brain surgery.”
Do you have other alternative ways to deal with pain? Additional tips for communicating with your HCP about pain? Feel free to send additional ideas to editorial@wegohealth.com!
Make sure to join us next week for more on Health Activism and Healthcare Professionals!
An article caught my eye in today's Wall Street Journal..."Stress So Bad It Hurts -- Really" by Melinda Beck. The article presents a patient's perspective on being told that chronic physical pain is caused by stress and it is "all in your head". Without further explanation, the patient feels indignant and angry that the health care provider does not believe their pain is "real". The medical community is slowly becoming more comfortable with the notion that psychological stress can exacerbate and even produce physical pain in individuals. Yet, we currently do not have a health care system that is set up to be multidisciplinary in response to chronic pain. There are initiatives going on around the country that begin to address multidisciplinary ways of dealing with complex pain issues. I am currently involved in graduate work at Tufts University School of Medicine's Pain Research, Education and Policy Program, the only one of its kind in the United States. As an initiative to share information and dialogue about pain management, we have started a blog (http://www.go.tufts.edu/pain) on the complex subject of pain research, education and policy and would welcome your voice. I hope that as President Obama considers health care reform, we as health care providers and consumers take on a vocal role of advocating for a multidisciplinary approach to true "health" care and not procedure oriented "illness" care. Only when we begin to acknowledge the innate connection between the body, mind and spirit will we truly begin to understand the complexities of the human body.