Man in a hospital gown speaking with a physician in a white coat about his pain levels

How to talk to your doctor about pain

Pain is subjective, so how can you help your provider understand?
January 23, 2019

When you are in pain, what do you do? You may reach for an over-the-counter pain reliever or perform a quick stretch, but, depending on the severity, you may also cripple into a ball or rush to the hospital. Feelings of pain can vary greatly depending on the kind of pain and the tolerance of the individual.

“If someone is feeling pain, whether acute or chronic, patients need know how to speak with their health care providers about it,” said Steven Bender, DDS, director of the Center for Facial Pain and Sleep Medicine at the Texas A&M College of Dentistry. “The hardest thing can often be answering the question, ‘How do you feel?’”

Types of pain

Before understanding how to answer that question about how you’re feeling, it is important to know there are different kinds of pain, acute and chronic. Acute pain is the normal, predicted response to various stimulus and is often associated with surgery, trauma or illness. This type of pain usually comes on suddenly and can vary in intensity.  Also, patients and health care practitioners can usually identify a specific cause.

Acute pain usually lasts less than three months or the approximate time it takes for injury to heal—if it lasts longer, then it can become chronic. Acute pain is your body’s helpful reaction that it can direct your health care providers to the cause or the problem, whereas chronic pain serves no useful purpose for the body.

“Normally, we cannot identify a cause for chronic pain, but that does not mean it is less real,” said Bender. “With chronic pain, people often wonder, ‘Nobody can find anything wrong, so why does it hurt?’. They begin to wonder if the pain is a figment of their imagination.” This is not the case.

Chronic pain is real, but unlike acute pain, cannot necessarily be cured. It can, however, be managed. Common examples of chronic pain are constant lower back pain, arthritis, multiple sclerosis, nerve damage and fibromyalgia. Chronic pain usually comes from ailments or diseases that have a constant presence.

How to discuss your pain level

Bender notes to seek help if your pain, chronic or acute, is interfering with your quality of life. Since everyone measures quality of life differently, this judgement is subjective. If your pain is impacting your sleep, eating habits, desire to be social or your capability to go to work or school, then it is time to seek help.

Because pain is so subjective, people often have trouble communicating how they feel to their health care providers. To circumvent this difficulty, health care providers often give their patients different tools like surveys or scales to measure pain.

Pain scales often have the user rank their level of pain from one to 10. These scales can use colors, pictures of facial expressions or numbers to represent the increasing or decreasing severity of pain. Bender also suggests using pain surveys like the McGill Pain Questionnaire, which provides terms for the type of pain they are experiencing—dull, stabbing, sharp, etc. These tools give both the users and their health care practitioners words that describe their individualized pain.

Bender suggests patients use these tools, many of which are found for free online, before their appointments. If patients are informed about their pain levels, then they will likely be their best advocate when managing it.

Common ways to manage pain

For both chronic and acute pain, Bender says there are plenty of pain management techniques that do not involve medication. There are some lifestyle changes, like reducing stress, staying physically active and getting enough sleep, that can help better manage the impact of the pain.

Health care practitioners can also prescribe pain medications to manage pain, but “they are now starting realize that opioids are not the greatest first defense against pain,” Bender said. “We now try to reserve opioid pain medications like hydrocodone for intractable or severe pains like cancer-related pain.”

Opioid risks

“People are at risk for developing substance use disorder after just three to five days of scheduled, round-the-clock opioid use,” said Joy Alonzo, M. Engineering, PharmD, clinical assistant professor at the Texas A&M College of Pharmacy. “If people are relying on opioid pain medications to manage their pain chronically, tolerance and dependence can develop which may lead to addiction.”

She mentioned some health care providers are starting to co-prescribe naloxone, an opioid overdose reversal agent, with prescriptions of opioid medication as a best practice and preventative measure against an opioid overdose, either accidental or due to misuse.

The Centers for Disease Control and Prevention recommends nonpharmacologic therapy and nonopioid pharmacologic therapy as preferred for chronic pain. If health care practitioner deem opioids necessary, then they need to evaluate the benefits and possible harms with the patient. They also need to discuss realistic goals for pain and function. Providers should prescribe the lowest effective dose for the shortest period of time, and discontinue if risks outweigh benefits.

Instead of prescribing medications, Bender often refers his patients, especially those with chronic pain, to seek counseling services. These services can help patients navigate the day-to-day pain until it goes away or lessens in severity. “There is not only one way to manage pain. It often requires a layered approach between various management techniques and health care practitioners to find what works,” he said.

— Mary Leigh Meyer

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