Throughout their careers, pain specialists must work to address common patient misconceptions surrounding pain treatment and outcomes. Here, five specialists discuss some of the more prevalent patient myths they encounter.
This is an ongoing series featuring five pain management specialists' responses to questions about the specialty.
Next week's question is: How can pain management specialists become more involved in shaping healthcare and pain management policy in the United States?
Submit responses to taryn@beckershealthcare.com before April 24.
Pamela D'Amato, MD, Advanced International Pain Management (Clifton, N.J.): I still get a great amount of hesitation from patients regarding lumbar epidural steroid injections. I feel that there are many patients that are apprehensive and think that lumbar epidural steroid injections could paralyze them. Even after I explain that the spinal cord is not located in the epidural space below a certain level, they are not always convinced, even after a review of anatomy on a skeletal model or MRI.
Anand Gandhi, MD, Laser Spine Institute (Scottsdale, Ariz.): The biggest misconception that I see in pain management is that some patients believe that medications are the primary way to alleviate their pain. In reality, patients need a comprehensive treatment plan, including cognitive, behavioral, pharmacological, surgical, and rehabilitative modalities, in order to successfully address their painful symptoms. Many patients are not aware of the multitude of treatment options available to help decrease their pain, and improve their overall quality of life. Also, pain should not be considered an inevitable part of the natural aging process. At Laser Spine Institute we often see patients who have suffered from neck and back pain an average of nine years before they come to us. In the past patients have either had to learn to live with neck or back pain or, at most drastic solution; consider open back or neck surgery. It is important physicians work with patients to formulate a treatment plan that allows for several options and considerations. Our endoscopic surgical approach at Laser Spine Institute gives patients a new option for relief from pain. By educating patients about the nature of their pain, I can work with them to optimize their functional recovery through the various avenues of pain management.
Farhad Mosallaie, DO, PhD, Sonoran Spine Center (Glendale, Ariz.): Some patients expect me to make them better, but then they don't or won't take a part in the responsibility of getting better. Patients must take an active role in this process. Exercise is a very important component — and this means more than going to physical therapy for two weeks, but making a lifestyle commitment to getting themselves better. Also, extra weight is a big factor with spine problems that don't get better and continue to cause aggravation and deterioration of a lifestyle.
Wendie Howland, MN, RN-BC, Howland Health Consulting (Pocasset, Mass.): The biggest misconception I see regularly is that the pain can be "cured" or eliminated, just because people are entitled to have this relief. For the vast majority of chronic pain patients, this is unrealistic. Pain management is not like the ads on TV: "I had pain, I took a pill, my pain went away!" Our culture is so sold on the idea that you can assign blame for something and then demand (and receive) complete relief (in the legal as well as the medical sense) from what they see on TV that the realities of actual pain management are truly inconceivable to them.
Most people can become more functional despite pain; this is not being heartless, it's being realistic. Pain does not stop function except as by attitude. We can give medications that will promote better function; it is not immoral to take opioids or ay other medication class for a lifetime if better function results (assuming they are the proper medication(s) for the type(s) of pain experienced).
Many people discover that if they give good effort into improving function despite pain, their pain does, in fact, lessen with time. And this is hard work. It does not come out of a bottle or a syringe or an operating room. Where is it written, outside of Madison Avenue, that it should be otherwise?
Karl Krantz, DC, Genesis Chiropractic Center (Middleton, Wis.): Definitely the biggest misconception is that the patient thinks that years of neglecting their body can be remedied in one or two visits. They will almost always say, "All I did was bend over to pick up the . . . and my back went out." After we do an exam and most often X-rays, I ask them, "Now, based on the evidence from your exam, do you think the problem was simply picking up the . . . or do you think your problem began prior to that?"
Funding for Connecticut's Drug Database to End This Year
Kentucky Physician: Prescription Drug Legislation Must Not Ignore Patients in Pain
This is an ongoing series featuring five pain management specialists' responses to questions about the specialty.
Next week's question is: How can pain management specialists become more involved in shaping healthcare and pain management policy in the United States?
Submit responses to taryn@beckershealthcare.com before April 24.
Pamela D'Amato, MD, Advanced International Pain Management (Clifton, N.J.): I still get a great amount of hesitation from patients regarding lumbar epidural steroid injections. I feel that there are many patients that are apprehensive and think that lumbar epidural steroid injections could paralyze them. Even after I explain that the spinal cord is not located in the epidural space below a certain level, they are not always convinced, even after a review of anatomy on a skeletal model or MRI.
Anand Gandhi, MD, Laser Spine Institute (Scottsdale, Ariz.): The biggest misconception that I see in pain management is that some patients believe that medications are the primary way to alleviate their pain. In reality, patients need a comprehensive treatment plan, including cognitive, behavioral, pharmacological, surgical, and rehabilitative modalities, in order to successfully address their painful symptoms. Many patients are not aware of the multitude of treatment options available to help decrease their pain, and improve their overall quality of life. Also, pain should not be considered an inevitable part of the natural aging process. At Laser Spine Institute we often see patients who have suffered from neck and back pain an average of nine years before they come to us. In the past patients have either had to learn to live with neck or back pain or, at most drastic solution; consider open back or neck surgery. It is important physicians work with patients to formulate a treatment plan that allows for several options and considerations. Our endoscopic surgical approach at Laser Spine Institute gives patients a new option for relief from pain. By educating patients about the nature of their pain, I can work with them to optimize their functional recovery through the various avenues of pain management.
Farhad Mosallaie, DO, PhD, Sonoran Spine Center (Glendale, Ariz.): Some patients expect me to make them better, but then they don't or won't take a part in the responsibility of getting better. Patients must take an active role in this process. Exercise is a very important component — and this means more than going to physical therapy for two weeks, but making a lifestyle commitment to getting themselves better. Also, extra weight is a big factor with spine problems that don't get better and continue to cause aggravation and deterioration of a lifestyle.
Wendie Howland, MN, RN-BC, Howland Health Consulting (Pocasset, Mass.): The biggest misconception I see regularly is that the pain can be "cured" or eliminated, just because people are entitled to have this relief. For the vast majority of chronic pain patients, this is unrealistic. Pain management is not like the ads on TV: "I had pain, I took a pill, my pain went away!" Our culture is so sold on the idea that you can assign blame for something and then demand (and receive) complete relief (in the legal as well as the medical sense) from what they see on TV that the realities of actual pain management are truly inconceivable to them.
Most people can become more functional despite pain; this is not being heartless, it's being realistic. Pain does not stop function except as by attitude. We can give medications that will promote better function; it is not immoral to take opioids or ay other medication class for a lifetime if better function results (assuming they are the proper medication(s) for the type(s) of pain experienced).
Many people discover that if they give good effort into improving function despite pain, their pain does, in fact, lessen with time. And this is hard work. It does not come out of a bottle or a syringe or an operating room. Where is it written, outside of Madison Avenue, that it should be otherwise?
Karl Krantz, DC, Genesis Chiropractic Center (Middleton, Wis.): Definitely the biggest misconception is that the patient thinks that years of neglecting their body can be remedied in one or two visits. They will almost always say, "All I did was bend over to pick up the . . . and my back went out." After we do an exam and most often X-rays, I ask them, "Now, based on the evidence from your exam, do you think the problem was simply picking up the . . . or do you think your problem began prior to that?"
Related Articles on Pain Management:
Infrared Light Therapy Found to Reduce Chronic PainFunding for Connecticut's Drug Database to End This Year
Kentucky Physician: Prescription Drug Legislation Must Not Ignore Patients in Pain