How to talk about pain so your doctor will listen

By Diane Cleverly, PhD, Founder of Concierge Conversations

Did you know that by 2020, there will be a shortage of about 46,000 primary care doctors in the U.S.?

Not only that, but Medicare and Medicaid reimbursements per patient have dropped. That means physicians are increasingly pressured to see more patients per day.

What does this mean for you, the patient? For one thing, your doctor has basically taken a pay cut. So it’s more important than ever to walk into a doctor’s appointment prepared in order to help you connect with your doctor on a personal level.

But we all know that pain interferes with communication. It may cause you to get less sleep, or take meds that make you a little foggy; both of these can affect cognition. Pain is subjective—it’s hard to talk about even in the best of circumstances. So how can you ensure that you and your doctor understand each other?

Pain Intensity Scale

Doctors will often ask you to describe your pain intensity on a scale of 1-10—with 1-3 being pain that doesn’t bother you much at all and 9-10 constituting an emergency. But people with chronic pain often downgrade their pain—in part, because you’re so used to dealing with it that it doesn’t register the same way it might for someone who’s just stubbed their toe.

A good thing to remember when using the pain scale is that giving a range of numbers can also be very helpful to your doctor: “Well, I woke up at a 3, but after grocery shopping I was at a level 7.” Go into detail—at what level do you typically take medication? At what level do you call your doctor?

Functional Impact of Pain

A crucial way to communicate your level of pain with your doctor is to talk about the functional impact it has on your day-to-day life. You may know how pain has changed your life in a larger sense; how it’s made you a different person, or caused you to give up activities you loved. But your doctor doesn’t. Here’s a little secret: When you talk about what the medical community calls “daily activities of living,” doctors often sit up and take notice.

So here are some specific things you should discuss with your doctor:

  • Are you able to work?
  • Are you able to engage in social activities?
  • Can you exercise? 
  • How is your sleep?
  • Are you able to shop for and prepare meals for yourself?
  • Are you able to do chores like laundry and cleaning?
  • Are you able to drive?
  • Are you able to handle your medication schedule?
  • Are you able to pay your bills?
  • Are you able to dress and bathe?
  • Can you climb stairs?

If you tell your doctor you’re having trouble with any of these things, it often will trigger them to investigate further.

Setting Goals

The other important piece to keep in mind when talking to your doctor about your pain is communicating your short- and long-term goals.

Here’s where the pain intensity scale is crucial. State clearly to your doctor, “My short-term goal is to go from a pain level of X to a pain level of Y so that I can resume [working, cleaning my house, driving, etc.]”

Explain the timeframe you have in mind. “I’d like to feel a difference within four to six weeks.” Now, depending on your disease state, this may not be possible, and you can negotiate that with your doctor. But it’s important to set a short-term goal, and to target getting your pain levels below a 5—which typically means an improvement in function.

Ask your doctor, “What will it take to get me there?” 

Next, move on to long-term goals. This may be simply getting the right diagnosis or it could be getting back to work (the number one thing most pain sufferers want). It may mean coming up with a long-term pain management plan or a strategy to reduce your risk of relapse. Whatever it is, communicate it.

Talking to Your Doctor About Complementary Medicine

Complementary therapies such as acupuncture, therapeutic massage, biofeedback, medical marijuana, or chiropractic care can be a touchy subject with some physicians—though they shouldn’t be. Ask your doctor in a nice way, “Would X therapy be helpful in achieving my short-term goals?” or “Do you think I could try X therapy along with standard therapy to manage my pain better?”

Your physician might even have other suggestions and resources for complementary medicine, so don’t be afraid to ask.

Above all, it may help to change the way you think about your doctor’s visit. It’s not a social call; it’s a business meeting. Keep your goals top of mind and stay focused. Set goals, track their progress, and refer back to them to assess your improvement over time.

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Diane Cleverley, PhD, is currently creating regulatory submission materials for clinical trials as a senior medical writer for Synchrogenix, as well as helping patients improve their communication with physicians to get better healthcare. Dr. Cleverley graduated with a PhD in microbiology and molecular genetics from Rutgers University. She has spent time with patients the past 25 years in healthcare and patient education. Dr. Cleverley has also been an adjunct professor for a number of colleges and universities, most recently Southern New Hampshire University, teaching a course in Health Literacy.