From medical school to residency, I’ve worked with colleagues who don’t prescribe pain medications for their patients who truly need them. Or they are just very hesitant about doing so. Some simply don’t believe in them. Others fear the legal implications like being named to a med mal or wrongful death lawsuit. And several avoid pain meds, specifically opioids, like the plague because of possible addiction risk even when their long-standing home med is an opioid prescribed by their PCP.
When it came to working with residents who didn’t believe in the efficacy of pain meds, it became a literal pain (pun intended) for me, the nurses, and the patient. The pain ladder exists for a reason: Tylenol to Tramadol to Norco. Not believing a patient is in pain, or at worse believing they can tough it out, is dangerous. Pour wound healing, infections, heart strain (even worse for patients with heart problems), poor sleep, anxiety, and depression are only a fraction of the possible complications. More doctors need to realize that not treating a patient’s pain can lead to a rabbit hole of consequences.
So how should a doctor approach pain? Of course, we start with the basics: Is the patient on any pain meds currently? Any opioids? Is this pain different from their usual pain? How bad is their pain?
But even before that, we must think about the cause because pain is an underdiagnosed diagnosis. Or at worse, diagnosed but grossly undermanaged. Oftentimes, the cause is clear-cut. A patient just had surgery, or a patient has cancer. A patient was in an accident or had a fall. But, what if the patient has pain stemming from a less clear or more complicated cause? Like psychological distress or CRPS (complex regional pain syndrome)? What about radiculopathy or drug toxicity? And sometimes, a patient has pain with no identifiable cause or pain due to overall poor health (smoking, obesity, sleep deprivation, etc.).
Coming down to it, the approach to pain should be the physician at the very least showing sympathy to the patient. Every single one of us has been in pain at some point in our lives. So we all know what pain feels like and what it can do to a person’s physical body and mental state. To shrug off a patient’s ask for something for pain because it isn’t the main problem is careless and disheartening. Pain should be taken seriously because it can be debilitating to the patient.
Yes, as doctors, we must be aware of how many pain meds the patient is getting, does their regimen consist of an opioid, and what exactly is their history of taking pain meds. We have to do our due diligence while at the same time not ignoring what the patient in front of us is saying and how they appear to our eyes. If a patient’s pain is uncontrolled, it can quickly lead to them distrusting the care team and medicine. They would no longer want to participate in their own care, which defeats the patient-centered care model we all like to champion, but only a few of us do so. Let’s do better when it comes to addressing a patient’s pain.
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