What is pain management?

Posted by martoof @martoof, Oct 18, 2021

Is pain management (PM) merely *not complaining*? Making pain subside or go away? Distracting oneself from the pain? I ask because I recently went to a pain management clinic, where after a lengthy intake/question process, I was prescribed Vicodin! Any qualified, serious input would be deeply appreciated! Thank you!

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I always wondered whether going for pain management (which has been prescribed for me ) would be a scam and now I know not to waste my money or my time. The expectation that a pain management dr. will actually approach issues in a unique way is a pipe dream.

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I believe pain management is prescribing you a narcotic for your ailment and managing the narcotic!

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I am sorry @martoof, to hear of this awful experience. That is not Pain Management. I would love to have people refer to the process (subspecialty) as "Active Pain Management" because it is not a passive process of adding another pill…

Pain management as practiced by my Pain Management specialist consists of the following:
– Review patient medical records for history and present and past symptoms and treatments
– Interview patient (in my case remote, due to Covid) to determine current state, hopes, expectations and willingness to fully participate
– Coordinate with primary care practitioner
– Explain the concepts of actual physical pain response, Central Sensitization Syndrome (CSS), Chronic Regional Pain Syndrome (CRPS), Neuropathy and philosophy of using a multi-pronged strategy to deal with whichever is causing the most problem. In my case, I have CSS and physical pain from arthritis.
– Explain that opioids do not really cure pain, and that the goal, if currently used, is to end or minimize their use. My body had never become dependent on narcotics for pain management, so I didn't have to break that cycle.
– Explain that the goal is to minimize and manage pain, as the underlying causes usually don't "go away"
– Develop a comprehensive pain management strategy. In my case it was a combination of physical therapy (PT) and myofascial release (MFR) by a specially trained therapist, a home routine of stretching, strengthening and walking, medication (non-narcotic), visualization exercises, and becoming attuned to what my body is saying to me.
– Review progress and adjust to find balance.

Since I started active pain management almost a year and a half ago, I have gotten my life back. It is not perfect – there are bad days and good days, I have learned to take them as they come, and which tactic to use for specific issues. I have learned that all of the strategies must stay in place for life – if you stop, the pain can come roaring back. I have hard surgery 3 times since I began active pain management, and managed recovery from each one with minimal opioids (2 days max) by using Tylenol, ice and my PM strategies. I use topical NSAIDS only for arthritis pain because I cannot use the meds internally, combined with ice or heat as needed.

Sorry, I cannot refer you to my pain management specialist, she operates on referral only, and from within the clinical practice where my primary is located. Mayo offers an inpatient Pain Rehab Clinic (https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691) There are other qualified Pain Management specialists and practices all over the country. Based on your experience, I would call and pre-interview any place to which I was referred to learn their philosophy.

I encourage anyone with a Pain Management experience to tell us about it.
Sue

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@sueinmn

I am sorry @martoof, to hear of this awful experience. That is not Pain Management. I would love to have people refer to the process (subspecialty) as "Active Pain Management" because it is not a passive process of adding another pill…

Pain management as practiced by my Pain Management specialist consists of the following:
– Review patient medical records for history and present and past symptoms and treatments
– Interview patient (in my case remote, due to Covid) to determine current state, hopes, expectations and willingness to fully participate
– Coordinate with primary care practitioner
– Explain the concepts of actual physical pain response, Central Sensitization Syndrome (CSS), Chronic Regional Pain Syndrome (CRPS), Neuropathy and philosophy of using a multi-pronged strategy to deal with whichever is causing the most problem. In my case, I have CSS and physical pain from arthritis.
– Explain that opioids do not really cure pain, and that the goal, if currently used, is to end or minimize their use. My body had never become dependent on narcotics for pain management, so I didn't have to break that cycle.
– Explain that the goal is to minimize and manage pain, as the underlying causes usually don't "go away"
– Develop a comprehensive pain management strategy. In my case it was a combination of physical therapy (PT) and myofascial release (MFR) by a specially trained therapist, a home routine of stretching, strengthening and walking, medication (non-narcotic), visualization exercises, and becoming attuned to what my body is saying to me.
– Review progress and adjust to find balance.

Since I started active pain management almost a year and a half ago, I have gotten my life back. It is not perfect – there are bad days and good days, I have learned to take them as they come, and which tactic to use for specific issues. I have learned that all of the strategies must stay in place for life – if you stop, the pain can come roaring back. I have hard surgery 3 times since I began active pain management, and managed recovery from each one with minimal opioids (2 days max) by using Tylenol, ice and my PM strategies. I use topical NSAIDS only for arthritis pain because I cannot use the meds internally, combined with ice or heat as needed.

Sorry, I cannot refer you to my pain management specialist, she operates on referral only, and from within the clinical practice where my primary is located. Mayo offers an inpatient Pain Rehab Clinic (https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691) There are other qualified Pain Management specialists and practices all over the country. Based on your experience, I would call and pre-interview any place to which I was referred to learn their philosophy.

I encourage anyone with a Pain Management experience to tell us about it.
Sue

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Thank you, Sue! It appears to me, then that the operational definition of "pain management" is training to be stoic. Exercises, visualizations, PT, etc., are suggested so that that stoicism becomes easier to present. Having been socialized under the "take two [or whatever amount] and you feel better quickly/soon/later" I have, INCORRECTLY, felt that many instances of pain can be "managed" this way. Context: 3 aneurysm repair surgeries; 2 clot removals; 1 knee & 1 hip replacement; chronic, severe osteoarthritis in back, legs, knees and hands; neuropathy and other nerve-related issues that *attack* the bottoms of both feet. Regarding surgeries – you take some meds, do PT, and in time you heal or improve. But the arthritis & nerve issues: Ice, heat, exercises, PT…….nothing REALLY helps. I see I have to conceptualize pain completely differently than I have been. Again, Sue – my thanks!

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I've concluded that "pain management" means "not complaining outwardly." ELIMINATING pain is equivalent to feeling too cold (pain) in your house, and thus turning the thermostat up (medication) – as opposed to putting on a sweater (MANAGING). The focus here is "I'M cold – not IT'S cold." [Sigh…]

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@martoof

I've concluded that "pain management" means "not complaining outwardly." ELIMINATING pain is equivalent to feeling too cold (pain) in your house, and thus turning the thermostat up (medication) – as opposed to putting on a sweater (MANAGING). The focus here is "I'M cold – not IT'S cold." [Sigh…]

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My definition: Pain management means learning to live your best life with the hand you have been dealt.

It certainly is true that we have wrongly been conditioned to believe that we should never have to be uncomfortable – cold, hot, hungry, in pain, unhappy…and to expect instant gratification or instant solution. Pain management is neither of those as you have pointed out. It is more a matter of learning to live a satisfying life IN SPITE OF THAT LIFE NOT BEING PERFECT. It is also a matter of personal choice.

Every day I get to choose –
Stretch, get up, shower and move around, eat a healthy breakfast, do my nebulizer and airway clearance, a few chores, a little exercise, some volunteering, prepare dinner, take rests or naps as I need to. Or focus on my aches, pains, shortness of breath, worsening arthritis, wrinkles, worries and lay on the sofa.

Smile, get dressed, do my hair, present my best face to the world, call a friend to see how she is doing. Or scowl, schlump around in pajamas with unwashed hair, focus on what hurts hurting, eat junk food and watch TV.

On bad pain days, I can choose to curl up in a ball and feel sorry for myself. Or I can choose to stretch, meditate or visualize something pleasant, take a short walk and refocus on something I enjoy, in spite of the (lessened) pain.

On really bad days I succumb – and stay out of everyone else's way. The rest of the time I choose to live.

The shining examples in my life were my grandfather, who kept going through numerous serious heart attacks for 31 years, until he fell back and died on his bed at 85, my Dad who was still helping people and dancing with my Mom up until days before his death from metastatic cancer, and my Mom, who with multiple disabilities, lived her life in "chapters", with a smile or a snarky remark for everyone, until she passed away in hospice after deciding she "couldn't do the rehab" one more time. Or my friend who just died after living with blindness, hearing loss, COPD, heart and kidney disease and the onset of dementia – travelling with his wife until just weeks before his death. He always had a cheery word and a story, and kept helping others in whatever capacity he could right to the end – even wanting to "get us something to drink" from his hospice bed.

This is not meant to be Pollyanna-ish – it is just the philosophy I have chosen. Pain management has simply made it possible. It needs to be tweaked at times to keep going, and I need to respect my body and its limits or it won't work.

Sue

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Hello @martoof @krisjb1 and @mikaylar. Thank you for contributing to the very interesting topic of "What is pain management?" It was a great thread to start @martoof and I look forward to hearing interpretations.

The old saying, beauty is in the eye of the beholder comes to mind for me. I watched several relatives live through chronic pain from wars, accidents, diseases. Some handled it better than others. Some took narcotics, some became alcoholics, some bulled their way through on sheer determination to not be defeated no matter the odds or outcome. I too became disabled with chronic pain and had to figure out which path I would take after watching and learning from those before me. I also took a deep look at who I was, and who I wanted to be. It was a tough conversation to have with myself.

Pain management is not a one size fits all approach, but it is a mind set. Its sure as heck not easy and takes hard work, determination and discipline. Although the same basic principles apply for successful, healthy pain management as @sueinmn so graciously outlined, pain management is ultimately what we allow it to be. Not everyone is built the same. Not everyone has the same mindset to learn and explore all the options, not everyone has the same opportunities. Each person has the right to make their own decisions on how they wish to manage their pain, their life. In the end, my belief it that you get out of it what you put in to it, even if in the smallest ways.

Here is a video discussing Central Sensitization Syndrome, a chronic pain syndrome, which is a bit of an umbrella over many chronic issues. Perhaps some concepts, for example acute verse chronic, will ring true for folks and be helpful in their path going forward.
https://www.youtube.com/watch?v=8defN4iIbho
This is not easy stuff, but as a Mayo Clinic Pain Rehab Center graduate, I am always happy to share my pain management experiences. Do you have experiences you would like to share?

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@krisjb1

I always wondered whether going for pain management (which has been prescribed for me ) would be a scam and now I know not to waste my money or my time. The expectation that a pain management dr. will actually approach issues in a unique way is a pipe dream.

Jump to this post

Personally I think that unless you have proof that the practice that you are going to for pain management is a dead-end that you should go with a open mind. You never know what you will find; think about this way: there have been people that have stumbled upon shipwrecks and found gold and you might find gold yourself. One person may not have a good experience, but you may have a different mindset and you could find something that works for you!!!!

REPLY
@sueinmn

My definition: Pain management means learning to live your best life with the hand you have been dealt.

It certainly is true that we have wrongly been conditioned to believe that we should never have to be uncomfortable – cold, hot, hungry, in pain, unhappy…and to expect instant gratification or instant solution. Pain management is neither of those as you have pointed out. It is more a matter of learning to live a satisfying life IN SPITE OF THAT LIFE NOT BEING PERFECT. It is also a matter of personal choice.

Every day I get to choose –
Stretch, get up, shower and move around, eat a healthy breakfast, do my nebulizer and airway clearance, a few chores, a little exercise, some volunteering, prepare dinner, take rests or naps as I need to. Or focus on my aches, pains, shortness of breath, worsening arthritis, wrinkles, worries and lay on the sofa.

Smile, get dressed, do my hair, present my best face to the world, call a friend to see how she is doing. Or scowl, schlump around in pajamas with unwashed hair, focus on what hurts hurting, eat junk food and watch TV.

On bad pain days, I can choose to curl up in a ball and feel sorry for myself. Or I can choose to stretch, meditate or visualize something pleasant, take a short walk and refocus on something I enjoy, in spite of the (lessened) pain.

On really bad days I succumb – and stay out of everyone else's way. The rest of the time I choose to live.

The shining examples in my life were my grandfather, who kept going through numerous serious heart attacks for 31 years, until he fell back and died on his bed at 85, my Dad who was still helping people and dancing with my Mom up until days before his death from metastatic cancer, and my Mom, who with multiple disabilities, lived her life in "chapters", with a smile or a snarky remark for everyone, until she passed away in hospice after deciding she "couldn't do the rehab" one more time. Or my friend who just died after living with blindness, hearing loss, COPD, heart and kidney disease and the onset of dementia – travelling with his wife until just weeks before his death. He always had a cheery word and a story, and kept helping others in whatever capacity he could right to the end – even wanting to "get us something to drink" from his hospice bed.

This is not meant to be Pollyanna-ish – it is just the philosophy I have chosen. Pain management has simply made it possible. It needs to be tweaked at times to keep going, and I need to respect my body and its limits or it won't work.

Sue

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Thank you, Sue, for expressing it like you just did.

You are so right about attitude and acceptance. I’m working on that right now.

The stress from trying to find what is wrong, what is causing the pain and what helps to minimize the pain is causing me headaches. I have to focus on the positive.

I will read your post again, and again….

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@jetsetter

Thank you, Sue, for expressing it like you just did.

You are so right about attitude and acceptance. I’m working on that right now.

The stress from trying to find what is wrong, what is causing the pain and what helps to minimize the pain is causing me headaches. I have to focus on the positive.

I will read your post again, and again….

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I know how hard it is to live with pain or other symptoms, not know the cause, or know the cause and know their is no cure – only management. I am happy to hear you are trying to focus tools to manage & live with your pain.

A wise doctor (mine) told me "We can keep on looking for a cure, or we can figure out how to live with it. Giving up is not an option." She was referring to her own diagnosis of Parkinson's as well as mine of Central Sensitization, arthritis, bronchiectasis…

I encourage you to keep focusing on the positive…you will find joy in life again.
Sue

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@sweetsurrenderwi

Personally I think that unless you have proof that the practice that you are going to for pain management is a dead-end that you should go with a open mind. You never know what you will find; think about this way: there have been people that have stumbled upon shipwrecks and found gold and you might find gold yourself. One person may not have a good experience, but you may have a different mindset and you could find something that works for you!!!!

Jump to this post

I watched the video about central sensitization syndrome and feel as if there is something missing between the "causation" portion of the discussion and the part where the patient is desensitized to pain. I can't understand how pain caused by an illness or disease that has no cure such as arthritis or terminal cancer can be alleviated by a course of therapy which appears to be akin to mental health work. While a serious disease or injury is present pain is a warning signal. What am I missing?

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@krisjb1

I watched the video about central sensitization syndrome and feel as if there is something missing between the "causation" portion of the discussion and the part where the patient is desensitized to pain. I can't understand how pain caused by an illness or disease that has no cure such as arthritis or terminal cancer can be alleviated by a course of therapy which appears to be akin to mental health work. While a serious disease or injury is present pain is a warning signal. What am I missing?

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I am living proof that pain from an incurable illness (osteoarthritis from head to toe) can be eased by therapy. It is not only mental health work, but that is part of it. And it is not only desensitization, but includes physical work to alter some habits which increase pain. Finally, the pain is not necessarily cured, but managed in order to improve quality of life.

There are incurable, intractable pains which are not caused by Central Sensitization, such as some end stage cancers, severe infections, or postoperative pain. Opioids are then a logical choice.

But when chronic pain sets up residence in the body, all kinds of muscles tense, we alter our body mechanics, related nerves react, we tense further and hurt more…the vicious cycle is initiated.

Pain management or desensitization teaches us to break the cycle using physical (PT, stretching, exercise, massage, acupuncture…) mental (counselling, visualization, meditation, faith practices…) medical (meds, injections, braces, surgery) dietary and social strategies.

Do I still hurt? Yes. Does pain affect my life? Some days. Am I glad I learned about it? Yes, I wish it had been around 30 years ago to help my Mom!
Sue

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