Re: I Don't Think My Pain Doc Believes Me

[Guest guest]

>

> Here's the deal: I just saw my new pain doc for the 3rd time last

> Monday. After examining me this time, he commented, " WHY are you here

> if you are only rating your pain a 5 or 6 each visit? Most of my

> patients usually rate their pain a 10! Your complaints are

> inconsistent with my exam findings-- " What do you think he was trying

> to say?

>

What a ridiculous statement from this doctor! I can't believe he said

this.

Doctors are *supposed* to be taught that these numbers are never to be

compared across patients - they are irrelevant when comparing one

person's pain to another person's pain. What one person rates a " 10 "

another person could rate a " 5 " - for many reasons, including the fact

that people don't perceive pain in the same way, but more importantly

for the fact that they don't apply the rating scale in the same way!

Those types of cross-patient comparisons are simply meaningless.

The only functional use for these rating scales is supposed to be to

establish a baseline of pain and then to compare change in pain

intensity for a single patient across time. For example, does *your*

pain change from day to day, from before to after treatment, from a 10

to a 5.

(BTW, I'm a psychometrician by training - I have a Ph.D. specializing

in the statistical measurement of " latent constructs, " which means I

study, teach and publish academic articles on how we

measure " unmeasureable " psychological variables, like " pain " for

example, by asking people to attach numbers on a rating scale to their

subjective assessments of these variables. So I do have some advanced

knowledge of how these scales are supposed to be used!)

Honestly, if you get the chance to discuss this with the doctor again,

I would suggest you say something like this to him:

" It's my understanding that self-report pain intensity rating scales

are invalid in comparing one patient's pain to another patient's pain.

I understood that the purpose of reporting these scales was to monitor

changes in a single patient's pain intensity over time, not to make

direct comparisons between patients. "

And then see how he replies to that!

The simple fact is, he was just flat out WRONG when he used the

statement he made to try to minimize your pain. You were right to tell

him that the exact same pain that you might rate a 5, someone else

might rate an 8, so him using that to tell you that you weren't

in " enough pain " is just wrong.

Heck, I wouldn't rate anything a 10 unless I was on the floor writhing

and screaming and unable to breathe, but I've seen other people calmly

state that they're in 10 pain all the time. How can that be? They're

aren't in any more pain than I am, they just use the scale

differently. That's the argument you've got to make with him.

Good luck. (And if your arguments don't work, maybe you should find

another doctor with a little more compassion!)

Cheryl in AZ

[Guest guest]

wrote: " Before I left, he wrote an order for an MRI and another script for

ultram. I spent a total of 90 minutes waiting to see him only to feel confused

afterward. I got the impression he doesn't believe I am in significant pain. "

I was just sent to an orthopedic dr for a workmans comp claim. I have been

treated with a drug regimin that is working relatively well. It keeps me up and

going at least to some degree. This new Dr ran his hands around me left foot and

leg, watched me limp (I have RSD that is affecting my left leg and foot - there

has never been an injury there, only low back) around his room, poked at my

lower back which nearly took my legs out from under me from the excruciating

jabs that created. he told me I " could lose a few pounds, I noticed a bit of a

belly there "

I asked him what would happen and that I did not have RSD because I didn't

come in to his office wailing in pain and " all RSD patients are affected the

same basic way and your pain level does not indicate the instance of RSD " .

He went on to tell me that he didn't know what was wrong with me but he would

start with a MRI with contrast, if that doesn't show anything well, I have some

other tests to do " .

I asked him, " What if you don't find anything with these tsts? " He replied " I

will send you to a pain management Dr " .

DUH>>>>>>>>>>> Thats where I already have been!!!!

I have a letter that I composed in regards to this Dr. visit. I am sending it

to his office, the workers comp company, and anyone else I think may benifit

others that may be having the same problems. If anyone would like a copy they

can e-mail me at : fiv3owls@...

I too have a great tolerance to pain and my daily management of a flat 4 on

this drug regemin keeps me unctional. When my pain is at a 7 or 8, I am in

trouble, a 10 would be like I was when this RSD had not yet been diagnosed. that

was pain I hope to NEVER feel again. I think the Dr thought that I was faking

it, he was rude, inconsistant in his suggestions and information, and had even

been so lax that he didn't have my file with him, it was at his house. I had to

give him all the information over again. He answered the question he asked for

me and never took into account that my pain level is now " controllable and

livable " BECAUSE of the meds I am on, without them I a, a much more sensitive

and boarder line suicidal. Its a scary me that is not nice or ever friendly as I

can't handle the pain that never ends.

I hope that you have a better time in your search of that pain free day!

Knowing and feeling your frustration, and with sincere compassion,

Tammy

wrote:

[Guest guest]

Hi Elaine -

I think there are two alternatives to answer your question:

1) When you give your doctor your rating, make very clear to him or

her every time what a " 10 " really means for you - for example, I

tell my doctor " You remember that guy who got caught under a rock

when he was rock-climbing and had to cut his own arm off with a

pocket-knife? That would be a 10 for me. My pain is a 7 right now. "

or,

2) Take a look at the Wong-Baker Faces scale, which a lot of doctors

use - you might actually be under-rating your pain! (Search the web

for " Wong Baker Faces Pain Scale " and you'll find it easily. Note

that it's usually shown as a five-point scale instead of a 10-point

scale, but you can just double the numbers and add a point in

between each picture.)

When you look at those faces, you might find that you would actually

rate your pain a higher number on that scale than you are now rating

it on the scale as you are thinking about it. When you consider

that the doctor is probably thinking about those pictures in terms

of the intensity of your pain, there's nothing wrong with using

those numbers to represent your pain - that's not " lying " - that's

just talking in the same numbers as she or he is.

There is a third option, of course. If your doctor is juse

completely unsympathetic, you could always find another doctor.

There is never a reason to stay with a doctor who minimizes or

undertreats your pain. That's just malpractice, and you deserve

better! Take your business elsewhere, and find a competent doctor

who will treat your pain appropriately.

I hope one of these ideas helps....

Cheryl in AZ

>

> So how do we let them know MAN IT HURTS! rate everything a 10

and feel

> like a liar??

[Guest guest]

Hi ,

something I learned on these lists is to rate your pain +2 whenever telling a

dr what your pain is. It's worked well for me and when my son was in the

hospital for his leg, it's worked well for him.

When I saw a counselor who was also a pain mgt counselor I told him my pain

was a 3/4 and he totally blew it off. Now a 3/4 to me is pretty nagging, always

there like someone pressing a bruise so I think it warrents attention - he did

not.

live and learn

much love,

barb k.

wrote:

Here's the deal: I just saw my new pain doc for the 3rd time last

Monday.

[Guest guest]

Cheryl,

You might want to add gender to that. There are real and socially

constructed differences in how males and females express and show pain.

Women are expected to be more emotional about pain and be in tears. Not

that this is true but it is what society expects. Men are usually quite

and will express pain more with body language such as a grimace. .

Using my self as a example I have very severe pain. Due to an injury and

a exacerbated a number of pervious injuries. With out some of the most

potent pain relievers I am non-functional I do not cry or say much I

just lay on my bed or couch and shut my eyes I usually do not say any

thing other than a polite but anguished leave me alone. To give an idea

of the pain I deal with iam on methadone 10 mg TID and Diluadid 4 mg

PRN.. I usually have to take it in the afternoon or evening if I have

done a lot, A tens unit and OTC anti_inflammatories if needed (Ibuprofen

naproxin) and now Lyrica ! I can do a lot as together this brings my

pain down to a tolerable 4 or 5

I have seen a woman with a compound fracture of her tibia last summer

she was in tears and screaming most men will just grimace and hold back

tears and try hard not to vocalize much other than a few expletives.

There really is not one way to assess pain easily. That is part of the

problem along with doctors in general being in fear of " over

prescribing " which is wrong of course. I think that is big reason why

many Doctors are undertreating pain.

Fortunately I have medical evidence of my injuries and the damage that

is not repairable.

Best wishes for a good day to all

Rick

>

=> What a ridiculous statement from this doctor! I can't believe he said

> this.

[Guest guest]

Have you watched athletes in pain. They're the biggest babies.

Especially football players!

[Guest guest]

Donna -

These pain scale descriptors are terrific!!!

Everyone here should print those out and take them to their doctors

to use.

Those are exactly the type of specific descriptions that are

necessary to understand and communicate what each number on the

scale " means, " so that the scale itself has some actual meaning in

assessing and monitoring our pain!

What a great contribution to this list, Donna - thanks so much for

taking the time to type it out here for us. I know I'm going to

print it out and take it to my pain management doc, because I don't

think he's got anything like this in his office (and he's actually

one of the best pain docs I've come across!) And I'm going to have

it with me whenever I go to any appointment with any other doctor or

physical therapist from now on as well!

And for those who are struggling to communicate with the not-so-

great docs, like and Elaine, I think this would be a great

weapon in their arsenal!

Cheryl in AZ

[Guest guest]

Being a football fan I can explain that it is a tactic to give t his

team a chance opt regroup and plan .It could be real pain . Some of the

injuries they receive end their careers or even leave them permanently

injured.

Getting hit by a 350 lb manic is not fun .In fact that is what caused

one of my injuries I took a job as a part time CO (Corrections officer)

second shift to pay for living while in grad school.

That incident separated my shoulder and that set off the string of

injuries that ended up with me in constant pain. I was mot correctly

treat for that injury they gave me Precodan and ice and a RX for a week

or so o of it not PT or any thing. Now I have a messed up shoulder.,

Neck arm and neurological injuries it would make a very long post , and

more .I did not cry I was mostly mad that 5 guys landed on top of me and

i got maced along with the nitwit who also took a 9mm round from me as I

was escorting him to from court that afternoon he thought it was a good

time to hit me and escape (. FWIW he was looking at life no parole for

multiple apes two of a child under 13! So he was not some petty thug. )

It could be a Mountain state thing too. Where men rarely cry and just

grimace a but and tell the doctor where the pain is and what it feel

like . For example I say my neck feels as if it is on fire and there is

a metal rod being forced down it. Or My hand feels a like I have it in

an electrical socket. That seems to work. Both are good colorful

descriptions that another can relate to at some degree. Then there is my

knee ah * Bleep *… is this what being over 40 is suppose to be like

? (41 To be exact)

Best to al I hope every ones weekend is going well as can be expected if

not better .

Rick

>

> Have you watched athletes in pain. They're the biggest babies.

> Especially football players!

>