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Evaluate How Effective Your Pain Treatment Is: Use the Evidence-Based Thinking Doctors Use

July 21, 2009 | Filed Under: All Articles | Comments(0)

To confirm if a particular treatment works or not: 1) pinpoint exactly what you’re supposed to observe in a specific amount of time; 2) try the treatment for 1/3 the claimed time to effect. Therefore, if the claim says that the product works in 6 weeks, try it for 2. 3) if you notice any changes, make sure the changes don’t fluctuate and remain stable from one day to the next; 4) if the changes you’re noticing are like the claimed effects, the product works FOR YOU; 5) if the claimed changes do NOT occur, or you have negative side effects, the treatment does NOT work FOR YOU. Change the treatment.

Dr. Adams, Grand Rounds, Scripps Memorial Hospital, Schaetzel Conference Center, 2004

THINKING EFFECTIVELY

If someone told you they could fly a 747, how would you check it out before getting on a plane they were flying? Sit them down at the controls and if they can take off and land the plane without frightening any passengers, only then should you agree with the claim that the person really does know how to fly a 747. If the plane either has a bad takeoff, or a bad landing, or passengers become frightened, the claim was not confirmed and should be rejected. The conclusion is the person who made the statement does NOT know how to fly a 747. It’s no different with chronic non-cancer pain. Especially because everybody responds differently to qualified pain treatment. It depends on other co-existing diseases, inherited predispositions, our personal history of injuries and where and how, if there currently is any tissue damage, nutritional habits, and lifestyle to mention but a few of the things we look at when assessing pain patients from the expert’s perspective of the multi-system phenomenon chronic pain really is.

MYTH: My primary care physician knows more about my pain than I do. Therefore, s/he is the one who should tell me what to do, then it’s my responsibility to do what my doctor says. If the treatment doesn’t work, that means it was a matter of bad luck and I should just learn to live with my pain.

FACT: Nonsense! As I proposed above about flying a 747, when anyone makes claims about important issues, I want to see with my own eyes if they can or not do what they claim they can, without killing me in the process. Wise pain patients follow the same reasoning: they check out the evidence supporting the claim that a primary care physician – with the education, training, experience and certification they have – can indeed effectively treat my specific chronic non-cancer pain disorder. After all, primary care physicians are trained to treat acute pain, so why not my chronic non-cancer pain? The problem is that acute pain has very little to do with chronic non-cancer pain based on very specific physiological, metabolic and functional deficits noted in an exhaustive number of controlled studies worldwide. Therefore, the likelihood is that a doctor of general medicine will have very little that they can “take to Court.” Practically, if they are not qualified to testify in Court about chronic non-cancer pain, theirs is not the qualified opinion you want guiding your chronic non-cancer pain treatment. Why? Because the most likely outcome is that the “747 will not take off and land without posing a significant risk to the passengers.”

IMPLICATIONS: For pain patients, that means that the likelihood is remote that a doctor of general medicine will necessarily “know more” than a person who has experienced their chronic pain for the average 7½ years that most chronic pain patients have had their pain. So, compared to a doctor of general medicine, most chronic pain patients will know more about their own chronic pain, and be a more reliable source of information about what works or not in their own life situation than the general practice physician. Today, unless you have perfect health insurance, qualified multi-disciplinary pain management treatment has virtually disappeared. So, the overwhelming majority of pain patients need to know how to screen, and who they allow to treat their chronic pain disorder, because the results, the numbers tell us, will be: worse pain, continued disability, a need for more medical services of all types, and a possibly irreversible pain disorder.

TEST OF THE PUDDING:  So, do not assume that a primary care doctor who has specialized in general, family or internal medicine will know better than you what the life circumstances of your pain’s occurrence are. You know better than any clinician what activity you over-did yesterday, what you didn’t do, what you ate that  disrupted your sleep which, in turn, made your pain worse, and a dozen other situations in which you were personally involved at the moment and your doctor was days away at his/her office. The first step in pain treatment is to stabilize your pain enough so you can start restoring your specific losses in functioning as soon as possible, including return ingto work. This can’t happen without considerable training and experience with all of the systems that feed into effectively restored functionality. The pill hasn’t been developed yet that does that. You, the patient, are a critical component of the treatment and self-awareness and self-management of your life circumstances is up to you to self-manage in a very practical manner. That’s not theory, the numbers speak. Every one of our patients with 5+ pain that had lasted more than 2 years needed the following multidisciplinary team to achieve optimal restoration of their functionality: first, someone qualified in prescribing the right pain medications for the right chronic pain disorders; second, someone qualified in changing habits and lifestyle to achieve specific patient-centered functionality restoration goals; and, three, a patient educated about the what to observe and do that gave them the ability to self-manage the conditions of their pain’s occurrence. That combination of elements is scientifically proven pain control and the way to obtain optimally restored functionality.

MORE ERROR-FREE DECISION-MAKING: The modern pain patient’s role is to become an expert patient, knowledgeable about the conditions of their symptoms’ occurrence and the changes in habits and lifestyle that impact the priority symptoms most and, then, with minimal error in decision making, to know what specific medication in what dose increases functionality optimally. Why? Because habits and lifestyle account for most of the extraneous effects on chronic diseases, and we patients are the ones who live those habits and lifestyle and are the ones who know best how to modify them within the reality of our own life circumstances. Practical thinking like this should tell you that a physician whose area of expertise is not pain management, nor habits and lifestyle, nor your specific life situation – regardless of how nice they are – will provide error-laden decisions that you can’t afford. We use this type of common sense in our daily lives every day, and we need to apply the same commonsense to the management of our chronic non-cancer pain.

Finally, since patients know best about the 90% of the actions that impact our pain on a daily basis, we have to mold our own team to obtain all three components of optimal functionality restoration. You don’t just want to “feel better” about your pain. You want to ably learn how to self-manage the conditions of its occurrence first. Then you can begin to see increased functionality, decreases in pain, and decreased need for costly medical services. If you’re in the right qualified hands, reliable increases in functionality that is relevant to you – like return to work – will occur. If you’re in unqualified hands, within a brief of time you pain will become as unstable as the unqualified treatment, get worse, and functionality will continued disrupted or get worse, with the need for more and more medical services peaking by the second month. Is you’re in the wrong hands, take the advice of chronic pain survivors… get out, quickly, before your pain gets worse.

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