Good news about bad pain

If your back, knees or neck persistently act up, you may be one of the 100 million people in the U.S. affected by chronic pain. It’s defined as pain that persists longer than 12 weeks…and you may be way too familiar with how your doctor greets you when figuring out what to do about it—asking you, at every visit, “How bad is it”? on a scale of zero to 10.

Now here’s the good news, no matter how bad your pain. There’s new thinking about how to evaluate pain—not just asking you how bad it is, but how it affects your life.

Health care professionals who specialize in treating chronic pain have moved beyond what doctors call a unidimensional evaluation to a multidimensional one.  It makes total sense, says  Cary Reid, MD, PhD, director of the Translational Research Institute on Pain in Later Life at Weill Cornell Medical Center, New York. “Pain is something that has many dimensions,” he says. “One thing important is the severity level.” So using what the doctors call the numeric rating scale or NRS, the zero to 10 question, is fine as a start.

After that, many more questions should follow, Dr. Reid says. “What we want to know is, what impact is it having on important aspects of your life?” Dr. Reid asks his patients affected by pain:

• Is it affecting your sleep?
• Is it curtailing your social life?
• Is it impacting your work?
• Is it a threat to your identity?

That last question may sound rather dramatic, but if pain has turned you into someone else—you don’t socialize or exercise or work as you used to–that’s a potential threat to your identity.

People who manage their pain well, with whatever treatment plan works for them, ”continue to have meaning and purpose in life,” Dr. Reid says. However, for others, who don’t, the pain ”is so overwhelming it doesn’t allow them to remember who they are as people.”

New Tools to Assess an Old Problem

The movement to evaluate pain not only by its severity but how it affects everyday life is partly fueled by the opioid epidemic. Doctors need to decide, with the patient’s help, when non-drug options may work and what prescription of pain meds may be needed if the alternatives don’t give enough relief. And one consideration is the effect pain has on functioning.

Many tools help a doctor go beyond the severity questions. One is called CAPA, for Clinically Aligned Pain Assessment Tool. This approach encourages doctors and patients to talk about the pain issue—how or if it affects activity and sleep and what effect treatment is having on it. If your doctor or nurse uses this, expect them to ask how comfortable you are, whether you have noticed changes in your pain, how the treatment is working, and whether you are sleeping and functioning well.

Another, meant for older adults, is known as the Geriatric Pain Measure. It also looks at how pain is affecting your activities, such as how far you can walk, if pain affects your sleep and if the pain makes you tired.

Pain is an Individual Experience

People experience pain differently, and the new perspectives take that into account. For instance, Dr. Reid says, one patient may rate their pain as an 8 of 10 in severity, but still be going to work, social activities and workouts. Another may give the severity a rating of 2, yet sleep for long periods or stay in bed, passing up social events and work. That’s why asking question about how the pain affects a person’s life and relationships is so crucial, Reid and other experts say.

Action Plan

If your doctor stops after asking “How bad is the pain,” your evaluation is not complete, Dr. Reid says.

What to do?

• Ask your doctor to go beyond the numeric scale in assessing your pain and your treatment.
• Initiate the conversation, telling your doctor exactly how the pain is affecting your life so a better treatment plan can be devised.
• If your doctor is not trained in pain management, consider asking for a referral to a pain clinic or a doctor who knows about treating your kind of chronic pain.

Support from others living with pain, as well as information, can help, too. Try the US Pain Foundation, an advocacy group of patients.  The site offers information on insurance coverage, medication safety and more. Want to test yourself? Here is the Geriatric Pain Measure. Results can rate your pain, but of course it’s no substitute for seeing your doctor.