pain

9 Tips for Communicating Effectively with your Doctor

/ Thomas Cohn, MD

doctor communicationEffectively communicating with your doctor is important whenever you have an appointment.  The time during a doctor visit is important and both the patient and doctor want it to be worthwhile.  Every person has a different style of communicating.  Most doctor visits today are too short (often because doctors are overscheduled).  Because of these time limits, it is necessary for the patient to be prepared for the visit. Below are some tips for effectively communicating with your physician.

Be Concise

Remember that all healthcare providers have limited be time to be with you.  Tell the provider about the problems you are experiencing. You can leave out the details about your most recent vacation that does not pertain to the visit.

Be Honest

Do not exaggerate or lie.  If you overused your medications, tell them why it happened.  Do not lie about losing your drugs. Most doctors will know if a story does not make sense.

Don’t Leave Anything Important Out

Do not leave out important details about your back pain. If you have had multiple back surgeries, tell that to your doctor.  Also keep track of the treatments that you have tried and what did or did not help.

If you have psychological problems, such as depression, these are also important issues to bring up.  Psychological problems are just as important as physical problems, so do not forget to include these in your history if you want successful treatment.

Medications

Medications are often an important aspect of treatment.  Keep track of what you are currently taking (including dose and frequency).  Nonprescription medications are equally important since many drugs may interact with each other negatively.

Be on Time

If you want your doctor to be on time, you must be on time.  If you are going to be late, notify the doctor’s office as soon as you can.

Ask Questions

If you have questions about your treatment or problem, ask them.  Doctors try to anticipate some of the questions and answer them when they explain the treatment plan, but we are not mind readers. We are trying to determine what is wrong and what needs treatment.  If you don’t tell us what you are concerned about, we cannot fully help.

Most Visits end with a Treatment Plan

This is a joint venture between the healthcare provider and the patient to solve the patient’s problems.  If you have questions about your treatment plan, ask them.  Please follow the advice given and the plan. Picking and choosing only parts of the plan will not lead to a good relationship or a successful resolution of your problems.

Respect the Office Staff

Everyone who has pain is uncomfortable at times, but do not be abusive or rude to the office staff when you are having a bad time. We understand you want to feel better, but everyone deserves a degree of respect.  In today’s world, both patient and doctor deserve respect, if the patient shows no respect to others, it is unlikely that you will receive ongoing treatment.

Remember that not all Problems are Curable

We are listening and trying to find an effective solution that is specific for your circumstances.  It is a team effort, and the patient is the most important member of the team.  You have to be involved, not passive, and need to participate in your treatment if you expect to improve.  In pain management, you need to be both physically and psychologically involved since the brain is an equal partner in pain.

Can Pain be all in your Head?

/ Thomas Cohn, MD

pain in the headMany patients wonder if their pain is all imagined and in their head.  Pain is a very complex problem.  Often the source is hard to determine and treatment is not totally effective.  The definition of pain also gives us a clue of the complexity.  The IASP, an international medical group that studies pain, defines pain as:

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Emotions are from the brain – therefore pain can be “all in your head” at times.

The Brain & Pain

The brain is the master of all sensory signals.  The role of the brain is to receive, interpret, and then provide a response to signals received.  Some sensory signals are from pain fibers in the periphery of the body, they travel to the brain, and the signals are then decoded in several different regions of the brain.  Acute pain sensory signals are often interpreted correctly and the body and brain can handle an appropriate response.  The body handles chronic pain signals differently.

There are multiple areas in the brain that respond to pain sensory signals.  When pain is chronic, there is an actual increase in pain sensory signals going to the brain and an increase in brain sensitivity to these signals.  Furthermore, areas of the brain that are near pain responders become stimulated, including emotional areas of the brain responsible for depression.  A short circuit occurs and emotions are often perceived as pain.  Treatment of pain that is it stimulated by emotions (such as depression) centers on successful treatment of the depression.

A Short Circuit in the Brain

There are also a few central pain syndrome triggered by damage to the spine or brain causing the brain to perceive pain, sometimes whole body pain, when there is no other injury.  The pain is very real, but the source is basically a short circuit in the wiring to the brain or within the brain.  Treatment of these problems is extremely difficult. Minimal pain medications help and central neuropathic medications like drugs for seizures are often the most helpful.

When pain is all “in the head,” there is likely an emotional component to the pain signals.  Chronic pain often stimulates this problem.  Treatments of the emotional components of pain are often as important or more important than medications for the pain itself.  Pain is complex, and treating all components is necessary, and since pain entails emotions, these must be treated equally.

The Link Between Anxiety, Depression, and Pain

/ Thomas Cohn, MD

pain and depressionAccording the International Association for the Study of Pain, pain is defined as:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This is one of the best descriptions of what pain is and is used worldwide to explain the experience of pain.

Pain and Emotion

Pain is an emotional experience.  Emotions such as happiness, sadness, and anxiety are generated in the brain.  Thus, pain and anxiety are intimately linked in the brain in terms of the locations that generate these perceptions.  As noted in the definition, pain has unpleasant emotional components, which most people perceive as anxiety.

The link between pain and anxiety is, in reality, more than just theoretical.  Sensation that is interpreted as pain is processed in several areas of the brain.  Some of the main regions of pain sensation are in very close proximity to the regions that process emotions of anxiety and depression.  When there is prolonged activity in the areas that process pain sensation, the areas nearby that process depression can be activated.  The areas then can spontaneously interact, pain sensations can be interpreted as anxious emotions, and anxiety can be misinterpreted as pain.

Anxiety and Chronic Pain

Those who have chronic pain often become depressed and anxious.  The two sensations become intermingled, and often the pain is greatly amplified by the depression.  Treating the emotional consequences of pain is often as important as treating the physical causes of pain.  If the depression and anxiety are not controlled, the pain is not controlled.  Once the depression and anxiety are controlled, insight into pain can occur and pain often becomes manageable.  There may be a physical cause to the pain, but if the emotional components are not controlled, then the pain is not controlled.

Comprehensive Treatment

Since pain, anxiety, and depression are intimately linked in the brain, comprehensive pain care involves treatment that is aimed at all aspects.  A comprehensive pain program looks at both physical control of pain and emotional control of the consequences of pain.  These programs link psychological approaches to pain, with physical methods.  A pain psychologist is often involved in patient treatment.  Medications for chronic pain that affect both physical signals of pain and emotional components then become understandable in their effectiveness.

Pain is a complex medical issue.  It has both physical and emotional components.  The physical side is the tissue damage and perception of signals.  The emotional side is the anxiety and depression that is linked to the chronic pain signals.  Treating chronic pain, due to its emotional components has long involved a multidisciplinary approach that includes psychological management.

The Relationship Between Diabetes, Vitamin D, & Pain

/ Thomas Cohn, MD

vitamin dA research presentation at the University of Chicago has indicated that vitamin D may have an effect on pain and depression in patients with type-2 diabetes.  The study indicates a relationship between pain and vitamin D supplementation.  Those with low vitamin D levels, who then received vitamin D, then had less pain complaints.  The study just shows that these problems of diabetes with pain and vitamin D have some connection.

Secondary Problems

As with many medical problems, many secondary problems can occur with diabetes.  Diabetes causes problems with multiple body systems, including the kidneys, eyes, blood vessels, and the nerves among many organs it damages.  It is no surprise that diabetes can affect vitamin D levels.  Whether treating diabetes more successfully and comprehensively is the answer or vitamin D has a correlation to pain levels is not known.  The study just notes that there is some sort of relationship.

Diabetes can cause multiple health problems.  Controlling diabetes is the most important way to prevent complications.  Pain is often a complication of the disease due to damage to the vascular system and nervous system.  Vitamin D may turn out to be an important aspect of controlling aspects of diabetes. However, it is unlikely it will be a solution to pain in diabetes.  The first and most important aspect in reducing pain in diabetes is to keep control of the blood sugars.  Most pain in diabetes is related to nerve damage, and neuropathic medications like Neurontin, Lyrica, and Cymbalta are some of the best at reducing pain symptoms.

More Research Needed

New research in pain control in any disease is welcome.  The most important thing in any medical study is understanding what the researchers have found.  In this study, researchers found that patients with diabetes type 2 and depression often have vitamin D deficiency.  The relationship between all these variables at this point is interesting but needs further study before any definite conclusions can be drawn.