You Ask. We Answer: How can I work with my doctor to manage chronic pain?

Franklin, Gary M. MD, MPH, FAAN

doi: 10.1097/01.NNN.0000515875.31686.68
Departments: Ask the Experts

How can I work with my doctor to manage chronic pain?

Q How can I work with my doctor to manage CHRONIC PAIN?

GARY M. FRANKLIN, MD, MPH, FAAN, RESPONDS:

AAsk your doctor to help you create a multi-pronged plan that may include rest, physical therapy, meditation, biofeedback, and self-care. Your doctor can also help you form a care team of physical and occupational therapists, social workers, nurses, and cognitive behavioral therapists.

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UNDERSTAND HURT VS HARM

For many people with chronic pain, staying active, no matter how gently, is important. Some people fear this because they think they'll harm themselves further. But there's a difference between hurt and harm. For example, certain physical therapy moves or stretching exercises may feel uncomfortable, or your muscles or limbs may feel sore or tender, but gently moving or reactivating them won't make your condition worse.

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STAY HOPEFUL

Some studies show that having low expectations about managing pain can actually make managing it more difficult. Many people can't see a way beyond their pain, and this is a normal reaction. But there's a way forward for almost everybody. Barriers to management are also normal, and pain experts have identified three strategies you and your doctor can use to get past them.

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1. Participate in your own care

Ask your doctor how you can be involved in your pain management. Keep a pain diary, for example, or use a mobile app to track symptoms. For an objective sense of whether the pain or your management of it is improving, keep a daily activity journal where you write down how far you're walking, how long you're sitting, and how often you're doing other favorite activities.

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2. Ask for additional help

Research shows that brief interventions of cognitive behavioral therapy can be helpful. Motivational interviewing is another technique to ask your doctor about. This type of counseling, which is administered by a doctor or a therapist, helps you identify and change patterns of resistance or behaviors that inhibit your ability to manage pain. This patient-centered form of counseling can be empowering. Biofeedback and mindfulness meditation are also helpful in reducing stress, decreasing tension, and changing how you respond to pain.

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3. Make sure your physician is also your partner

Your doctor should assure you that he or she understands what you're going through and is going to help you and be there for you. His or her attitude should be: I am not going to abandon you as long as you are willing to work with me.

Dr. Franklin is a research professor in the department of environmental and occupational health sciences and neurology and health services at the University of Washington in Seattle. He's also medical director of the Washington State Department of Labor and Industries in Olympia, WA.

© 2017 American Academy of Neurology