The way physicians assess and treat pain has come under scrutiny recently, as the country continues to experience an epidemic of opioid addiction.
There’s a big push to get away from prescribing heavy-duty pain killers, and to try different treatment approaches such as therapy, mindfulness meditation, or yoga.
Yet patients in pain want relief – and they want it quickly, which can sometimes put a lot of pressure on physicians.
“A solid assessment is the essential foundation for a good outcome,” said Michael Clark, Director of the Chronic Pain Treatment Program at The Johns Hopkins University School of Medicine in Baltimore, Maryland.
“Interviewing somebody with chronic pain is more than just the number or the rating they give you,” he added, referring to the popular ‘zero to ten’ pain scale.
“Pain is an experience that covers many domains in their lives, and that touches on many different aspects of medicine and psychiatry.”
Clark asks patients about their lives, their family histories, pain triggers, and alleviating factors.
When choosing a recipe for treatment, he says function is the main focus.
“While I would always like to get to zero pain, it’s better to be doing the things they want to do in their lives with some pain, than to try to get to total pain relief before they do anything.”
Clark says in some situations, he recommends psychotherapy for patients to learn coping skills, or problem solving skills. Sometimes, it’s physical therapy, or other forms of therapy like meditation or mindfulness, or yoga to deal with the anxiety and distress that comes with chronic pain.
These options aren’t always popular with his patients, and Clark says he’s fine with that. He says buy-in is important as patients shift from a passive approach of taking pills – to being an active partner in their treatment.
“It’s important to have the patient’s engagement and acceptance, and that’s part of the art of this practice. To some people, meditation comes easy, and they move into this easily. Other patients say ‘what are you talking about?’ and then you look for another type of therapy that will fit with their lives.”
Going forward, Clark says he could envision more engagement from the healthcare community at large, trying facility outreach and team-based approaches to help patients dealing with pain.
“The biggest problem we have is just ignorance. It is well-meaning, but the every day practitioner has not been taught about pain, and tends to default to what they have always done, or what is simplest, and that tends to gets us into trouble.”