how your doctor makes a chronic pain diagnosis

Pressures on doctors
“Doctors don’t want patients to suffer, they want people to get better,” says Bill McCarberg, MD, founder of the Chronic Pain Management Program at Kaiser Permanente in San Diego. “But they feel stress, they feel time constraints, they have to deal with pre-authorizations, it’s not the kind of practice they wanted. They’re stressed, and that leads to moving patients along.”

“As a doctor in today’s medical system, it’s difficult to deal with chronic pain conditions,” agrees S. Sam Lim, MD, a rheumatologist at Emory University School of Medicine in Atlanta. “Most practices are forced to see a certain number of patients in a limited amount of time. [With chronic pain] it’s not so simple as five minutes, a few questions, and handing out a pill. It takes some time. And our system isn’t set up for that.”

Emotions can cloud the diagnosis
The emotional effects of chronic pain may also make diagnosis more difficult. Maggie Buckley, 46, from Walnut Creek, Calif., learned this the hard way. She suffers from Ehlers-Danlos syndrome, a rare genetic tissue disorder that leaves her with chronically painful joints.

“If you say ‘it’s really depressing and upsetting me, I’m in so much pain,’” Buckley says, “doctors will see it in terms of emotion and treat it as an emotional problem, referring you to psychiatric care or antidepressants.” That is sometimes the appropriate treatment route, because antidepressants can treat chronic pain and there is a link between pain and depression, but you need to stand your ground and make sure any treatment is addressing your specific problems.

Be gentle about your pain, but be firm
It’s important to be clear about your pain and explain the way it impacts your life when you’re talking to your doctor. Don’t be intimidated. Stand your ground, calmly.

“Patients really need to be persistent about their complaints in a way that is constructive to get across to the physician that this is something real,” says Dr. Lim. “There are some physicians who are more open to listening than others. It may take a few doctors to find a marriage.”

“You have to go very gently to start with,” advises Ann Jacobs. “Listen to what the doctor has to say first.” Then, if you’re not satisfied, press harder. But remember that the most important thing is to create a relationship with your doctor in which you’re a team, both looking for the best way to alleviate your pain. After he or she has assessed your needs, you can consider seeing a pain specialist.