Pain in the…

I attended a really interesting pain management workshop last week. It was intended for both providers and people with acute/chronic pain, which was an interesting mix.

One of the “patients” asked an intriguing question…

It’s so difficult to manage pain and I haven’t been satisfied with my providers, so I’m “doctor shopping” yet again. How do I find a new pain specialist without making it seem as if I’m drug-seeking?

How indeed.

I’ve noticed an interesting paradox among health care providers of all cloths. We use the pain scales during our assessment, but if the patient’s behavior and physical signs don’t “match” the number, we question and become skeptical. For example, a patient rates his pain an “8” but he’s not moaning and writhing. So he must not really be hurting that much, right?

But then with the patients who do moan and writhe and “act the part” (so to speak), we consider them malingerers and over-actors and drug seekers.

We expect people in pain to act just right, or we don’t believe them, one way or another.

So here’s my question… Is there a better way to assess pain? How do we accurately gather information about an entirely subjective experience? How do prescribers protect their licenses from people who are truly drug-seeking? And how can you really tell the difference between drug-seekers and people who just can’t find a provider who is satisfactorily addressing the pain that is very real to them?

I’m at a loss. What do you all think?

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