Misconceptions about chronic pain can do harm to people with legitimate medical problems. Patients with chronic pain can and should be treated. Dispelling these damaging myths should raise awareness and encourage more people to seek help with a professional trained in treating chronic pain.
Chronic pain is defined as pain that persists for at least 6 months. It may result from an initial injury or problem, such as a herniated disk, serious infection, or surgery. There may be an ongoing cause of pain, such as arthritis, scar, or cancer. Some people suffer chronic pain in the absence of any past injury or evidence of damage to the body. Unfortunately, many people with chronic pain do not get the help they need, and the effects may be devastating, not only for the sufferer, but also for an entire family.
Chronic pain is a huge problem in terms of its human and economic toll -- it disables more people than cancer or heart disease, and the annual cost to society in terms of medical treatment, lost working days, decreased productivity and workers compensation is a staggering $100 billion a year.
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Myth #1: If the doctor can’t find anything wrong medically with a patient with chronic pain, it must be "in their head.” Maybe they’re crazy.
Fact: Chronic pain is not “in your head.” It is a legitimate medical condition that can and should be treated. Unfortunately, the exact cause of chronic pain cannot always be found. Pain is a complex personal experience and not all doctors have received adequate training to treat it. Pain management specialists are specifically trained to recognize and treat common and unusual conditions that cause ongoing pain. Although not all pain has an identifiable cause, there is an effective treatment for most painful conditions.
Myth #2: If people seek treatment or complain about their pain, it means they’re weak.
Fact: Seeking treatment has nothing to do with being weak. Many people with chronic pain feel trapped and helpless, and do not want to burden anyone else with their problem. It is important for them to realize that there is no need to suffer because effective treatments are available.
Myth #3: People who take powerful opiate ("narcotic") pain medication become drug addicts.
Fact: Opiates are highly effective for many types of pain and can be given safely. Physical dependence from pain relievers is different from addiction. Drug addiction is characterized by compulsive craving and use of a drug, which results in physical, psychological, and social harm to the user. An addict’s drug use continues in spite of predictable, consistent harm (self-destructive behavior). The vast majority of people taking opiate medications for pain management do NOT become addicted. Drug dependence, where the body becomes used to the presence of a drug, can occur with the prolonged use of some pain relievers.
Myth #4: The side effects of opiate painkillers turn people into zombies and can stop their breathing.
Fact: Most side effects are mild, tolerable, treatable, occur at the beginning of therapy, and fade with time. Common side effects include constipation, drowsiness, and dry mouth. Careful adjustment of dosages and attention to patient concerns help alleviate most side effects.
Myth #5: People with chronic pain treated with opiate pain medications will have to take more and more medication as time goes by to get the same pain relief (tolerance).
Fact: Most patients have stable dosages with time. Increases in medication dosage usually result from worsening physical or psychological status.
Myth #6: Some people don’t want to get better because they benefit from being in pain.
Fact: Most people don’t enjoy being in pain. Research shows that exaggerating about pain and malingering are actually rare. Assistance from others when pain limits activities or financial compensation for a work-related injury is appropriate for people who suffer from chronic pain.
Myth #7: Ignoring the pain will make it go away.
Fact: In most cases, ignoring ongoing pain will not make it go away, and it may even get worse. It is better to seek help from a caring, experienced specialist when pain persists and becomes a problem.
Myth #8: People should try to overcome their pain by pushing themselves to do things.
Fact: Knowing one’s limits and pacing oneself can help people manage their pain. Overdoing it and pushing too hard can exacerbate pain.
Myth #9: If someone looks good, they can’t be in pain.
Fact: Many people with chronic pain go about their business and do as much as they can, in spite of their pain. There are no outward signs of chronic pain (unlike acute pain). Just because people look comfortable does not mean they are not in pain. This misunderstanding creates much emotional distress for people with chronic pain.
Myth #10: Many people have been to several doctors, but haven’t been helped. They’ve been suffering from chronic pain for so long, they’ll just have to live with it.
Fact: With few exceptions, there is no need for anybody to live with unbearable pain. A variety of treatment options are available, but it is important to find the right doctor. Just as people see a cardiologist for heart disease or an ophthalmologist for an eye ailment, pain management specialists are trained to treat chronic pain. Patients should make sure they see a qualified pain specialist to get the treatment they need. Pain management specialists will listen carefully to the history, perform a thorough physical examination, and may refer a patient for other tests or medical consultations before coming up with a comprehensive plan for care.
By The Hospital For Special Surgery
This page is updated on May 13, 2013.
Comments
#1 Re: Ten Myths Of Chronic Pain
I had to laugh at Myth #10. It says
"With few exceptions, there is no need for anybody to live with unbearable pain."
One of those exceptions, at least in the good old USA, is...money. I've spent over $50,000 out of pocket and have decimated my savings. Given increasing insurance premiums, deductibles and copays, who can afford to keep searching for an answer???
#2 Re: Ten Myths Of Chronic Pain
I am just entering this cycle. my back, shoulders, knees, elbows are in constant pain. my hands are getting mnumb. So far, tthey are saying osteoarthritis, but is was sudden in onset, coincident with taking interferon and ribiviran. they also did not find a spondylolesthesis that have been previously identified in another state by MRI. (ten years ago). How good are xrays for finding problems? what is joint arthrosis? the definition is a joint.
#3 RETORT TO ANONYMOUS PRACTITIONER
It is very very sad that a few bad apples make it hard for us people who have real chronic pain and over top of being in pain, have to try and convince their doctor they they are in need of pain control. What's better, taking 20 tylenol #1 per day, or getting something stronger and not have to take as much? If a doctor has taken an oath to help people, one of the best things they can do is not try and put us all in the same boat. I know that taking that much tylenol kills my liver over time.
But when you're like me, in pain, 24/7, you do what you have to do to get relief. I am so hurt when I go into the "what can I do for you today?" question, and I'm scared shitless to say that we need to adjust my pain meds because either my back has gotten worse or I've been on the same dose for so long that it doesn't' have the same kick, and I need assistance from my gp, to get my meds amended. It's really humiliating and degrading and deflating. I'm trying to lead as normal a life as possible, I've lost my career as an Insurance Broker, and now I feel like a dog with my tail between my legs. My doctor has a really hard time with prescribing opiate medication, which is what I need, to get any relief.
I had 2 back surgeries, on my lower back, L4/L5/S1 got worked on. The first operation got botched and they had to do it over again. Since then, I've had 2 rhazotomoies, I've had epidural blocks, I've had botox injections. If that support documentation doesn't suggest that I'm genuinely looking for pain relief because I have permanent nerve damage in my low back I don't know what does. What really hurts is when my general practitioner goes "No Barbara, I'm not increasing anything. You'll just have to deal with it".
It makes me what to shoot myself in the head.
Sincerely,
Barbara Brown
Armstrong, B.C.
Posted December 7, 2008
#4 Is there an answer?
I have been on lortab for 6 years now for a back injury but have been dealing with unexplained chronic pain since high school. I am now 34. I also feel like i am too much for my doctor bless her soul she has tried her best to diagnose me but i have fallen into the category of "chronic pain". I dont want to take medications to live,but in the year that i slowly weened myself from 4 lortab a day to 1 i saw my life fall apart and physicall independence slow to a crawl. I lost my wife and daughter mostly because of irritability and because i was unable to work. I was a gifted athlete no stranger to what normal pain feels like.what i deal with now is not normal. i hate the fact i take a pill to mask the pain just enough so that i can still enjoy life to some degree. Right now i take two to 3 pills a day depending on the day and severity of pain.i had to admit my life is more productive with the medication,but at what costs. I wish i knew the answer.My doctors have thrown around ideas like scleroderma,fibromyalgia,even just plain kidney disease my ex wife would say its just in my head. i would be willing to surrender to anything or anyone that could make me normal again.
#5 "A Lot"
I would ask you or anyone else to question the use of the term "A Lot" when referring to drug seekers. The incidence of abuse is just two to four percent in the chronic pain population, which is the same rate it is found in the general population. Sounds like a normal bell curve to me as one would find studying most any phenomenon in the social sciences. I think your education regarding chronic pain and chronic pain patients may be seriously out of date. If you are nervous about prescribing narcotics, then cll and teamup with a chronic pain doctor in your area for consults. Do a good job of documenting and cover yourself legally. Give periodic drug tests that screen for abuse and have a narcotic agreement that makes it clear to patients when you will stop prescribing and for what reasons.
It's a lot more clear cut than you think. Your a practioner but your not the morality police. Isn't the potential to do more harm greater by not prescribing? If someone is abusing, they will be found out in a few months if everyone practices pain medicine responsibly. How may of your patients have began using illegal and unsafe drugs because you were afraid to treat their pain effectively?
I believe your becoming confused about your role as a practioner more so than you are becoming cofused about who to treat or not treat. You are thinking of opioids as a moral issue, or perhaps you are afraid of the legal problems that could happen. But if you practice responsibliy these risks are minimized. So I challenge you respectfully that you may be associating these substances in a negative moral manner. And that would really be unfortunate, because they can mean an improved quality of life for those with chronic pain. At the very least, go get some continuing education so you can make a more informed decision.
Respectfully,
Nicole Laurent
#6 Living in Pain
Living with constant almost unbearable pain has completely changed my life for the worse. Once I was a productive member of society, now my life is ruled by the cycles of my pain. In spite of the above article saying "no one should have to live with pain" no one has come up with a solution to my problem (fibromyalgia and migraine headaches). I guess I'm one of those few who do not benefit from medicine, although I get partial relief for both conditions. I continue to see specialists but they don't listen well and have a one track mind (use of anti-depressants for depression for which I do not react well). I am open to alternative therapies but few are offered to me. It could be the major problem is the type of medical coverage I have, I am restricted by many limitations although I am totally covered by a major plan. I think my primary care person is tired of me and I am too much for her, but I don't have a choice. I want a doctor to really hear me, to offer choice of therapy within my means. I also have to see a psychologist as this situation has caused me major depression. I don't want to live with this pain, my uselessness in society and my poverty since I have had to stop working, but life goes on doesn't it? Thanks for listening.
#7 living in pain
I find solice in the fact that there are many worse off than me. I can still walk even exercise sometimes.I still breathe the air i still see my family .when i think of what could have been it just brings me down so i dont. Never forget the connection between the mind and the body. what do u have to lose by taking on your affliction like you would take on an enemy. with feirce and unrelenting disposition. i take pain pills to get through my days but am always fighting.there are times i feel life is so unfair but then i remember it is unfair to many of us.I pray for everyone on this site. i pray you all have strength to live every minute the best you can.
anonymous
#8 I understand
I also have chronic pain. Mine is assosiciated w/ scleraderma which has attacked several internal organs & caused gastro paresis (which limits my appetite and prohibits my digestion of food) among several other things. I have also been prohibited from working (luckily I worked for an excellant company which I had paid for long term disability for 20 yrs and I am now getting social security disability) and I have also had my driver's license taken away due to my disability. I am only 47 yrs old and 2 yrs. ago my husband decided he could no longer "deal" w/ it so he had an affair w/ his secretary and then begged to come back and after much consideration (and I'll be honest, NEED) I agreed to let him return after assuring him things would have to change. He begged, cried & he came back for SIX DAYS before he left again and is now living w/ her. As a result, I spend 90% of my time alone, trapped in the house. I am very lucky to have family close and my faith in God. I also agree that my Dr is tired of me & the endless paperwork he has to complete to "vouch" for my illness. Even his staff has been rude and inconsiderate at times and I feel I am not taken seriously. It is very hard w/ an HMO to find a Dr. who can reaaly help and take the time to go thru the huge amt of medical history necessary and it is very cost prohibititive! Even w/ the disability coverage I still have to pay 30% of all my bills and it gets very difficult to make ends meet. Something needs to be done for those of us who need to find the RIGHT Dr. who is willing to invest the time necessary to help us. Know that I will pray for you and I know how depression can get the best of us sometimes. But it is "sitional" depression which means if someone cared enough to diagnose and treat properly the "situation" would not be quite so depressing. Again, my thoughts and prayers are with you.
#9 The other side of the coin
As a practitioner, I'm always troubled by the idea I may be denying someone deserved pain relief. The fact remains that pain cannot be seen and sometime a cause for pain cannot be found. There are a lot of drug seekers abroud who are eager to abuse the system and their practitioner in order to abuse drugs. It ain't all that clear cut who should get narcotic pain medication.
Sincerely,
Robert H. Galloway
#10 fellow health care worker
I seen alot of pain patients and some I believe are drug seekers........ One thing I do know there is no way to tell who is who and to deny a patient adequate pain relief is Just unethical. I look at it this way our job is to help the patient thru what ever crisis there in whether chronic or short term. Drug seekers will eventually crash and burn and end up in rehab where that problem should be addressed. But, dont confuse treatment of even knowm drug seekers with what your oath entailed, treat, cure and compassion........ even if it means prescribing to drug seekers, because believe it or not they can still exprience all the pain and discomfort as other people and let the pysche and rehab people do there job instead of second guessing whether someones pain is genuine. everyone has different tolerance and pain is subjective.