Seeing your doctor about pain
This article is a shout out to our local GPs. As human beings we are very complicated, physically, mentally and emotionally. We expect answers about the muscles, bones, blood vessels, organs and neurons in our body. Add to this an infinite number of thoughts and emotions that we bring to a doctor's consulting room.
There were two recent conversations that prompted me to research and write this article.
Firstly, a discussion during a client inquiry, she said, "I just want my doctor to tell me what I can do to help my pain," a reasonable request?
Secondly, was a recent online discussion amongst my fellow postgraduate students studying chronic pain management. Yes, as chronic pain specialists they know the importance of 'self-efficacy', we take responsibility, and 'self-help', meaning you and I make changes.
Self-Help For Chronic Pain
If we exclude taking medicine, as taking a pill, in my thinking, is not self-help. What I'd think of, how can I help reduce my own pain?
o Changes to my lifestyle
o Check out my thoughts and habits
o What I eat and drink
o How much movement and exercise I do
I think you'd all agree the above are all important influences in our health and wellness. But are our doctors able to provide help and advice in these areas?
Therefore what are three things that would be useful for us to receive from our doctors? Perhaps, many doctors would like to have, or to do but are challenged to deliver.
Number One - Time To Talk About Pain?
Medical systems worldwide are designed to give your primary service provider, your local doctor and local medical centre the ability to allocate between five and fifteen minutes for your health consultation.
Personally I can (back this up) from personal interaction with chronic pain clinicians. In the process of my post graduate study of chronic pain at Edinburgh University, and more recently at Otago University in Christchurch, fellow students complained they couldn't have time to spend with patients. They would like to discuss, listen or explain your pain issues, but in 10 minutes?
Last week, in our final online class discussion focussed on ways to improve the treatment results for chronic pain patients? The unanimous conclusion was more time to talk! More time to listen!
A neurologist, that's a clinician who checks your nerves are working, connecting and sending the right messages to the right places from your brain to your body, is a specialist in understanding your pain. This specialist was given a total of twenty minutes for each of his patients who he generally only sees once.
How can patients and doctors have an informal conversation in ten minutes? Buchbinder and Harris (2021) suggest patients "voices be heard and their views considered and they need to be involved as actively as they can" page 227.
From my interaction with the clinicians in postgraduate study they want to listen to patients, to understand and talk to educate patients about their pain. That's exactly the need expressed by my client.
"Doctors need to work within a system that allows this."
Chronic Pain Is Complex To Explain - Harder To Understand
Chronic pain, unlike blood pressure cannot point to a number and say 'to much pressure on the walls of blood vessels, your heart has to work too hard'. Then your doctor can briefly explain your blood pressure is too high and needs to be reduced. To explain the neurology and neural networks involved in the persistence of pain cannot be explained (with the person understanding) in ten minutes.
Number Two - Giving Advice On Diet And Nutrition
Remember the lady asked about self-management for her pain? When I studied postgraduate pain management I was surprised to learn nutrition wasn't considered a standard part of pain management. Generally pain clinics include a medical specialist for medication, psychologists, physiotherapists and occupational therapists. When I, being a naturopath, enquired about a person's diet on a particular ankylosing spondylitis case study, the response was he eats "a normal adult diet." What's that? If this is the response of a university educator in chronic pain management, how can we have expectations of our local GP being able to provide nutritional advice about diet and its impact on our chronic pain?
In many countries malnutrition, due to overeating food that lacks nutrients that our body needs for health, is increasing. Since the inception of naturopathy we have believed the key ingredients of good health is dependent on the food we eat, and the movements we make. So where does nutritional advice come into our primary care system?
Returning to our expectations of advice from our own GPs. Are our GPs sufficiently educated about not only day-to-day nutrition we all need, but also the more specific nutritional needs of chronic pain and also the growing number of chronic diseases. There is a lot of attention, media and marketing about food to tempt us to eat the 'wrong' food. However, there is an opportunity in primary care for good education about food, as Ganis (2013) assures us patients would trust the information given by their GPs. Is it fundamental to this trust that our doctors have the best training and up-to-date information on nutrition?
How Well Are Doctors Trained In Nutrition?
Returning to Ganis (2021), she found the number of nutrition-related learning objectives varied considerably in postgraduate training. Crowley (2016) found the majority of GP's they surveyed in Australia wanted to provide more nutritional information and care, were interested in more education and training to build up knowledge and skills. One problem they cited was time constraints of a normal consultation. Somewhat ironic, didn't I mention that above?
Referring back to the overeating mentioned earlier and the need for interventions - doctors and primary healthcare could be the place to start. We need only to consider the impact obesity can have on our body, especially our muscles and bone health, both interrelated to the development of and living with chronic pain. The increase in chronic diseases will also increase the demand for nutritional care in the future (Anandacoomarasamy et. al, 2009; Ball et.al, 2012).
Number Three - The Doctor-Patient Relationship
The final part of this article is our relationship with our local GP. Many of us lack this relationship possibly due to large practices, lack of follow-up, patient expectations and more.
I contrast today with when I was a child, growing up in a rural area in England. We had a family doctor, Dr. Holden, in fact there were two GPs in the practice. Dr. Holden brought on a younger, and in the opinion of a 10-year-old girl, very good-looking doctor. When I was sick with the standard, at that time, childhood illnesses such as mumps, chickenpox, etc. in a home visit, the doctor would sit beside me, talk with my mom and suggest rest, time and the occasional aspirin or cough medicine. Our doctor knew our family and he was part of the community - one of the "pillars of our community" like the primary school headmaster and the vicar.
As I write this, the above seems more like fiction. Doctors now are mostly employed in larger practices, sit most of the day in an office with a continual stream of 10 to 15 minute appointments. Often typing information into a computer on the desk as we talk.
Considering this article is about lifestyle and health, writing about their daily work conditions it must be very difficult for a doctor with his or her daily workload to ensure that they themselves can be healthy.
If we also relate this to the rest of the article and the stress that G.P.'s are under on a daily basis from the system we critiqued above and the demands of somewhat "Google prepped" patients. I hope this article will inform us, who just think of our GPs only when we're sick, or when we're stuck and take our demands for wellness, cures or medications expecting to be fixed, with perhaps a little bit more understanding.
For many of us who are members of large practices may see a different doctor each visit due to the "system" as mentioned earlier in this article. Rural areas are more likely, increasingly over time being moved to telehealth services. This is excellent provision for expertise and to be able to provide a wider range of services to remote areas. But again this makes my childhood experience sound somewhat quaint?
Mike Stone (2003) writes in the British Medical Journal, that the relationship between doctor and patient is special where both doctor and patient should value this partnership. In relation to chronic pain patients Mehl-madrona (2021) found when doctors knew more about patients' lives this increased doctor empathy, reduced pain and improved the doctor-patient relationship.
I began this article with a patient's wish to learn self-care from her doctor. I'm not aware of plans here in New Zealand to promote self-care but I found research from the UK to show that as many as 75% of the public would feel more confident about taking care of their own health and well-being if they were provided with guidance and support from an NHS professional.
This somewhat long quote is from a survey done by Department of Health in 2005 - some time ago?
"Education and training are key, as change may require a culture shift from professionals being the principle providers of care and patients as passive recipients, towards more emphasis on preventative care, healthy lifestyle and patient involvement in their own care of minor, acute and long-term conditions-with professionals providing a supportive, advisory, educational and skills training role." p 1.
Finally, it's interesting to note that doctors are aware of the need for lifestyle education, and enabling self-help such as my client inquiry. People want to know how to improve their self-care. Let's hope we are all given the opportunity and take that opportunity to improve not only our pain but also our general health and wellness.
This article is comprised of research collected and reflects her own opinion and should not be taken as advice for chronic pain. If you have pain this should be checked by your doctor.
This article is the personal opinion of the author, Jean Jordan who is a natural therapist who works online with people who have chronic pain and related stress and anxiety.
Learn more about Jean and discover her philosophy and holistic approach.
References
Hippocrasy, How doctors are betraying their oath, by Rachelle Buchbinder and Ian Harris. Published by New South.
Ganis, L. & Christides, T. (2021). Are we neglecting nutrition in UK medical training? A quantitative analysis of nutrition-related education in postgraduate medical training curriculums. Nutrients, 13, 957.
Crowley, J., O'Connelll, S., Kavka, A., Ball. L., Nowson, C. A. (2016). Australian general practitioners' views regarding providing nutrition care: results of a national survey. Public Health. 140, 7-13.
Anandacoomarasamy, A., Fransen, M., March, L. (2009). Obesity and the musculoskeletal system. , 21, 71-77.
Ball, L., Desbrow, B., & Leveritt, M. (2012). An exploration of individuals' preference for nutrition care from Australian primary care health professionals. Australian Journal of Primary Health, 20, 113-120.
Stone M. (2003). What patients want from their doctors? BMJ; 326 :1294
Mehl-Madrona, L., McFarlane, P., & Mainguy, B. (2021). Effects of a life story interview on the physician-patient relationship with chronic pain patients in a primary care setting. The Journal of Alternative and Complimentary Medicine, 27(8), 688-696.
Supporting self-care in primary care, by Ruth Chambers, Jill Wakeley and Alison Blenkinsopp. Published by Radcliffe publishing (2006).
Department of Health. Public attitudes to self-care baseline survey. London: Department of Health; 2005.
Jean Jordan
Want to find simple effective ways to reduce your chronic pain (change for each blog/topic) without increasing your stress and overwhelm? This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques. After over 20 years of having my own pain clinics pain I started Natural Pain Solutions online business to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home. Learn more about me here.