What Not to Do When You See a Doctor for Pain
In the course of their training, medical doctors receive specific education about how to identify malingering, or faking behaviors, for a variety of illnesses, including pain. People can have a variety of motives for seeking medical care, that do not involve actual illness. Sometimes this is just as simple as attention for a lonely person, but with pain, the primary concern is drug seeking behavior, trying to get psychologically and physically addictive substances for intoxication purposes, rather than pain relief. This may help you to understand why your doctor is not responding to your pain complaints in a way that you consider to be appropriate. If you respond in certain ways, your doctor may be more likely to suspect that you are not being honest with her, and that you have ulterior motives in your search for pain relief.
First, do not say that your pain is higher than a 10 out of 10. To an emergency physician or a pain management physician, they would characterize a 10 out of 10 pain as literally losing a limb by traumatic amputation. It is hard for most people to imagine that anyone short of that kind of traumatic injury can have that severe pain. I need to be clear - you may be hurting that much, but if you claim that your pain is a 10 out of 10, or worse, a 12 out of 10, the physician will think that they cannot believe your accuracy as a reporter. As pain is a subjective experience, and can only be defined by you, it is important that your doctor believes you when you tell them how much you are hurting. Also, if you rate your pain as a 10 out of 10, you have nowhere to go if the pain actually gets worse. No way to really convey how much worse the pain may have become. Also, rather than just providing a number, be sure to tell your doctor what you can do, what you cannot do, and what your goals are in seeking pain treatment. This is much better than providing a simple number on a scale.
Do not report that your pain is a 10 out of 10 all day, every day. Pain doesn’t work that way. Pain ebbs and flows. It gets worse, then it gets better., in a cyclical fashion It may still be bad, but it does improve across a given day. Anyone who says that their pain is very high all day, every day, are likely to be suspect. To be clear - there are some neuropathic pains that can be severe pretty much all the time - but even these patients do report that their bad gets better sometimes, even though it never really becomes bearable. Be sure to tell your doctor what actually does work for you - that can really help in guiding the types of therapies she might provide. Again, for almost all pain patients, some things help, just like some things make the pain much worse.
No matter how much you feel that your doctor is not listening to you, do not exaggerate how much pain you are feeling. Be as honest as you can with your doctor. If you feel that you are not being listened to, try to explain that to your medical provider. Do not give a higher number in an effort to try to elicit further attention. This can backfire, in that your provider may not believe you. Worse, if your pain does get worse, you will not be able to appropriately convey that to your provider.
Do not ever ask for a specific medication. This is a huge red flag for potential abuse for medical professionals. If you say that there is one, and only one, medication that provides you relief, this will be a red flag for any physician. The reason for this is especially with opiates, their mechanisms are quite similar, while their intoxication effects can be quite different. If you are looking for intoxication rather than pain relief, you are much more likely to report that you would like a specific medication.
No matter how angry or frustrated you are, do your best to remain calm. First, getting angry is not likely to get you what you want. In general, people who are drawn to medicine are rational, logical people, and do not react well to threats and antagonism, and react even more poorly to extremes of emotion. Even if you are tempted to say you might need to talk to an attorney, it will never be to your benefit to tell your doctor that you think that. Threats are never a good negotiating tactic, until you are ready to burn all bridges.
If your doctor recommends alternatives to medication, try to remain open to them. Be very clear what strategies you have tried, and what worked and what did not. Another red flag is that physical therapy, occupational therapy, and other approaches did not help you at all. If you shut down any potential alternatives to medication, unless you provide a good reason, this is a red flag that you are seeking drugs.
Finally, if you hear the words “inappropriate pain,” run, do not walk, to find another doctor. Pain is a subjective experience, and pain can exist in the complete absence of tissue damage. But many physicians do not know this, or do not understand it. If they tell you that your pain is “inappropriate,” that means that according to the lab results they have, the scans, and other tests, they do not feel that the pain that you are reporting is compatible with the condition that they believe that you have. Any doctor who has this kind of bias will likely prove very hard to work with, because at baseline, they do not believe you or your report of your pain severity.
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