The role of the primary care physician (PCP)
Provided by Stephen Hilty, MD, an internist practicing in San
Luis Obispo, CA
Finding a PCP:
Resources: friends, Hospital/ER nurses, Urologist
Internal Medicine (Adult Medicine) vs Family Practice (Adults/Children)
Check MD's background/training: Board Certification/Re-certification
Discussing Your Expectations:
Letter of referral to Urologist, Massage Therapist, Accupuncturist,
Chiropractor, Pain Specialist, Photon Therapist, Psychologist/Psychiatrist,
Supervise All Medications:
If someone else prescribes something new, notify your PCP Keep
a list of what you take, what you've tried (including so-called
Interpret test results
Discuss a specialist's recommendations
Research a question
Pain Management (Bone Pain vs Nerve Pain)
Example: Broken Arm VS Hypersensitive, Electric, Numb,
Bone Pain: Acetominophen, Ibuprofen, Tramadol, Morphine-like
Nerve Pain: Tricyclic Antidepressants, Anti-Seizure Medications
(Neurontin), Anti-arrhythmic Medications (Mexilitine)
Relationship with "S.O."
Living with Chronic Pain
Psychosocial Aspects of Chronic Pain Management:
Because of the effect pain can have on ones life the psychosocial
aspect of care can have significant impact on treatment. Studies
have shown that almost two thirds of patients with chronic nonmalignant
pain have coexisting symptoms of depression or anxiety.
Because of a feeling of helplessness many patients have when
trying to relieve chronic pain, patients are in danger of assuming
what is called a "sick role." After countless doctors
office visits, referrals upon referrals, and a myriad of diagnostic
tests, some patients will become the victim of their pain symptoms.
This sick role can have "positive" benefits such as
attention, sick leave, and sympathy from others. However, it
can also cause significant isolation and feelings of worthlessness.
Learning to manage the pain can be just as important as treating
the pain. By not falling victim to chronic pain, patients maintain
control of their health and the potential for curing their symptoms.
The Mayo Clinic offers the following suggestions for managing
chronic pain and avoiding the sick role:
Chronic pain has been shown to improve only when a patients
level of activity increases. While many patients will feel bound
to a sedentary lifestyle because of their pain, there are always
exercises and rehabilitation no matter how difficult the situation.
Physical therapy should focus on reconditioning, stretching,
and pain reduction modalities (e.g. ice, heat, ultrasound, etc.).
Focus on Others
Be active in your community, stay in touch with friends and
family, and look for volunteer activities. By keeping active
with friends and family you will feel less isolated, and by
maintaining active in your community you will pay more attention
to others problems and less to your own.
Accept Your Pain
Dont deny or exaggerate your symptoms, and perform your
daily functions accordingly. If there are things you need help
with, dont be afraid to ask. If you are avoiding things
you can do, make an effort to do those activities.
Abnormal weight and sleep disturbance have both been shown to
adversely affect pain treatment. Get a good night of sleep on
a regular schedule and eat a healthy diet. Harmful habits such
as tobacco, alcohol, and drug use all make pain more difficult
to treat. Specifically, nicotine is associated with increased
pain levels, and may decrease the effectiveness of treatment
medications by altering their blood levels.
Suggestions from Patients with Chronic Pain
What We Have Learned In 20 years
of helping each other, weve learned a lot. Here is a bit
of that wisdom:
We need the support of others who experience and understand
Recognizing emotions helps us to understand ourselves.
While our pain is certainly not all in our heads, attitudes
and expectations do make a difference.
Learning how to relax is essential. It helps prevent tension
and redirects our attention on to things we have some control
Staying active, within realistic limits, can help us remain
flexible and strong and reduce our sense of suffering.
It is important to set realistic goals and chart our progress
Chronic pain not only involves the person with pain but the
family as well.
Hearing others talk of similar feelings and experiences caused
by pain reduces our isolation.
There are no wrong feelings.
Half the battle is won when you begin to help yourself.