Hi guys! This blog post is an opinion piece. I did not interview anyone or research any medical journals for this blog post. Instead it is my opinions that are based off of my own personal experience with chronic pain, my research over the last two years, and the experiences I have had as an ER nurse. This may come off as a critique to doctors, but really it is meant to be a critique of the healthcare system as a whole. As a patient, I found doctors to be unhelpful in treating my pain. As a nurse, I see every day that I go into work, doctors and other healthcare professionals have not been adequately prepared to treat chronic pain. That is not by fault of anyone specific doctor, but rather the institutions that provide healthcare professionals with education. Treat your doctors with respect and kindness, but also advocate for yourself and don’t be afraid to say that you deserve better.

“You can get better. You can significantly decrease your pain.”

When I first started seeing doctors for my chronic pain, they were pretty pessimistic. They rarely ever spoke as if my pain was curable. It was obvious they thought that I was going to be in pain forever and that their main job was to help me manage the pain. But I didn’t want the pain to be managed, I wanted the pain to go away. I never left a doctors appointment feeling hopeful or capable of improving. I always felt depressed and isolated after each appointment.

My physical therapist appointments were different. They were so friendly and optimistic and their social skills were significantly better. It was so nice and refreshing to have someone joke around with me and talk to me as if I was capable of healing from my pain. They didn’t throw false hope at me and say things like, “This is going to cure your pain”. A lot of our conversations were me venting about my pain and brainstorming things I could try to decrease my pain. We would talk about my wins, my losses, my relationships, etc. I left every appointment feeling like I was more than a person with chronic pain and that I was on a trajectory of healing. Most importantly, they gave me hope.

Hope is so powerful and so undervalued in medicine. Hope is what gave me the motivation to reach out to experts on chronic pain because I so strongly believed there was someone out there who knew how to make my pain go away. And I was right. Without hope, I wouldn’t have been on the search for better answers and resources. I could have just laid around in bed all day and waited for someone to come and save me.

If a doctor or healthcare professional has not said this to you lately, I want you to know that I genuinely believe you are capable of significantly decreasing your pain and living a life that brings you joy. I don’t like to use the word “cure” because sometimes pain comes back (which does not mean you cannot make it go away again), but some people do end up being cured of their pain. There is nothing wrong with having your pain cured as your main goal. Hang onto hope. You can do this!

“I don’t know, but let me point you in the direction of someone who does”

I had multiple doctors appointments where my doctor would say, “We have tried everything I know at this point. I don’t know what else to do with you”. Hearing something like that sucks. I remember being convinced that I was a hopeless cause and no doctor would be able to treat to me. I didn’t see the point in getting second or third opinions. I would often have pain flare ups after these appointments because my depression and anxiety would get really bad. I’m lucky that I had my dad in my life being an optimist when I was not capable of thinking that way. He would always say, “It’s not if you get better, it’s when you get better”.

I wish my doctors would have said something like, “Hey, I don’t really know what to for your pain at this point, but let me get you a referral or point you in the direction of a resource that may be more helpful”. Every doctor is different and there are so many different ways to treat chronic pain. Maybe you don’t even need a new doctor. You may benefit from working with a pain psychologist, a dietitian, a physical therapist who specializes in your area of pain, etc. In a perfect world, every doctor would know the resources that are available for each chronic pain condition and they could just give you the list. Unfortunately we don’t live in that world, but I want you to understand their are so many resources out there for all types of pain. Check out the resources portion of this site if you’re interested in learning more.

Sometimes you have to see a lot of doctor before you find a treatment that truly works for you. I met a girl who went through 12 different doctors before she found one who was successful in treating her symptoms. Keep in mind that she worked with each doctor for several months before moving onto a different doctor. She was not bouncing from doctor to doctor. The 12 doctor created a treatment plan that made almost all of her symptoms go away and her quality of life drastically improved.

Don’t be afraid to reach out for more opinions and be on the lookout for resources that are not being mentioned in doctors appointments.

“Instead of trying opioids, could we try this method instead”

I’ve been the person who has requested opioids and immediately told no. It was such a painful conversation to have. I remember explaining to the doctor that my sister’s wedding was coming up and that I so badly wanted to be pain free for her wedding. I said that I just wanted to take one for this event and then I wouldn’t ask again. He said no and it crushed me. But what hurt the most is he didn’t provide any other ways for me to gain some amount of pain relief for that big day.

Knowing what I know now about chronic pain, there was so much more he could have said. He could have said, “Instead of trying opioids can you try BioFreeze, a lidocaine patch, acupuncture the day before, seeing a pain psychologist, etc.” But instead he left it at “no”.

I can’t pretend that I can read a doctor’s mind, but in this moment I strongly felt that he had zero empathy for what I was going through. This was one of several doctors appointments where I had to bite my tongue to keep myself from screaming. All I wanted was for someone to really just talk and brainstorm with me on how to reduce my pain. There are very few doctors who really understand how to help people with chronic pain. I’m hopeful that this will change in the future.

“Chronic pain is usually way more than a purely physical problem”

Medical and nursing schools provide very little education on chronic pain despite how many people it affects worldwide. Yet it is starting to become more common knowledge that chronic pain is impacted by things like stress and our mental health. None of the doctors I saw ever addressed my mental health, my stress levels, my poor sleep habits, my social isolation, or anything else that could impact my psychological state. They focused solely on the pain as if it was purely a structural problem.

Treating pain as if it is only structural can delay healing in a lot of people with chronic pain. The pain experienced in chronic pain is often exacerbated by a variety of psychosocial factors. You may genuinely have a problem with your back and that may bring your pain to a 4/10, but if you’re also struggling with anxiety, depression, lack of sleep, a stressful job, unhealthy relationships, isolation, and high levels of self-criticism, you may experience your pain at a 9/10. To only address the back pain and ignore all other contributing factors is to ignore the depth and complexity that comes with chronic pain.

It wasn’t until I started advocating for myself and bringing up my mental health in doctor’s appointments that they started addressing my depression, anxiety, and poor sleep habits. Now when I work with patients in the ER who have chronic pain, I strongly encourage them to prioritize their mental health and look into psychosocial factors that may be increasing their pain.

“I believe you”

To experience chronic pain is miserable and depressing, but to be in pain and have doctors treat you as if you’re lying can be absolutely gut wrenching. No one can truly understand or comprehend the pain you experience. Pain is an incredibly subjective experience. Even when we say the pain is a 6/10 or 9/10, no one truly knows what that means for another person. I know what my 10/10 pain feels like but I don’t know what your 10/10 pain feels like.

I never had a doctor explicitly state that they didn’t believe that I was in pain. Instead I had doctors who told me that I was capable of going back to work, even after I explained to them that going grocery shopping was so painful it had brought me to tears on multiple occasions. I had doctors who refused to give me pain medications because based on my diagnosis and test results they believed that my pain wasn’t that bad. I had doctors who had told me to learn to live with the pain, as if my level of suffering was something that someone could learn to live with. There were so many times when it was evident that my doctors did not take my pain seriously.

To hear a doctor say the words, “I believe you” would have been so refreshing. Just some acknowledgement that my pain was real and that it was causing real damage to my quality of life at the time.

“Here’s a step by step plan. What do you think of this?”

I like step-by-step instructions when it comes to literally anything. Cooking recipes are great like that. Getting started in my career as a nurse involved following specific steps. Learning to drive a car or ride a bike involved doing what I was instructed to do. In so many areas of my life, there has always been a guide of some sort.

Except for chronic pain. When I first started having pain, I definitely believe that I would go to the doctor, the doctor would tell me what to do, I would do what the doctor said, and then the pain would go away. That did not happen. The reason for this is that there is no one set of instructions that work for everyone. But there are guidelines.

After over two years of researching chronic pain and having gone through it myself, I understand that there are certain approaches that work best when it comes to treating chronic pain. One of the best approaches is using the biopsychosocial method. Here’s how I would explain this to a patient newly diagnosed with chronic pain:

“I’m so sorry to hear that you have been experiencing so much pain. In order to effectively treat your pain, I would like to take an approach that focuses on your physiology, your psychological processes, and your lifestyle habits. This will involve different variations of medications, physical therapy, pain reprocessing therapy, and making improvements in your diet and sleep. It will take some time and effort, but I believe that we can reduce your pain. What are your thoughts?”

I don’t say this because I think I’m smarter than any doctor who treats pain or because I think all my research experience makes me qualified to tell any medical professional how to do their job. I say this because I wish that was the conversation any one of my doctors would have had with me. Unfortunately, our healthcare system is designed to only allow doctors a small amount of time with each patient. I do believe that there are a lot of amazing doctors out there who are doing the best they can with the time and knowledge that they have at their disposal. I know that the doctors that I work with genuinely care about their patients and wish they could do more for patients with chronic pain. They work incredibly hard and they do as much as they can for each patient.

I do believe that with better healthcare education on chronic pain, our healthcare providers can be better equipped to have conversations like the one I wrote above. Until then, we have to advocate for ourselves. We have to go into each doctor’s appointment asking, “What’s the plan? What can I do at home each day to decrease my pain? Are there any other healthcare professionals that I should be meeting with? What do we do if that medication doesn’t work? Are there any resources available that I should be aware of?” Don’t be afraid to bring someone to your doctors appointments with you so they can help you advocate for yourself. Write out a plan for yourself of the steps you will take each day to improve your physical and mental health.

“You’re going to have to make some lifestyle changes if you want to reduce your pain”

It would be really nice if all you had to do was take a pill for a few weeks and then the pain would permanently be gone. As far as I know, this pill has not been created yet, but I will announce it to the world if anyone ever does create this magical pill. Our healthcare system has trained healthcare workers to focus on medications, physical therapy, and surgeries when it comes to treating chronic pain. These things work great for a lot of people and not so great for a lot of other people. Yet we have been convinced by the healthcare system that those are the only treatment options. This could not be farther from the truth.

From the start of my chronic pain experience, I was prescribed medications like amitriptyline, nortriptyline, and gabapentin. I went to physical therapy. When these didn’t work, I was offered a surgical procedure. I refused the procedure because I was told there was a 25% chance that my pain would get worse. This was too high of a percentage for me. Over the years, I have discovered many treatments for my pain that were non-invasive and were successful in studies and trials. I also discovered a long list of lifestyle changes that could be made to reduce my pain.

The only lifestyle change that was ever recommended for me was to drink more water. This was not very helpful. What I needed doctors to talk to me about was how to make my insomnia go away, how to start an anti-inflammatory diet, mindfulness exercises, cognitive behavioral therapy, pain reprocessing therapy, health relationships, and stress reduction techniques.