4.  Talk to your physician

Separating myth from truth

No one knows your pain like you do. In fact, you are the only person who can tell if your current treatment is effectively controlling your pain. That's why you need to discuss the effectiveness (or otherwise) of your pain therapy with your doctor, nurse and family members.

'Being a martyr' will not benefit anyone - you must be open and honest. Keep a diary of your daily experiences with pain, so that you can remember important details when you next see your doctor. All too often, people don't seek proper pain relief or even mention pain to their doctors. Some patients keep quiet because they misunderstand the nature of chronic pain, or because they have unjustified fears about treatment:

"I'll get addicted to pain medication" - even though medical research has shown that, when taken properly, drugs can relieve pain without addiction.

"If my current treatment can't control my pain, then I'll just have to learn to live with it" - even though this may not be true. If one type of therapy is not effectively controlling your pain, another often will. Ask your doctor about the pain therapy options available to you.

"People will think I'm weak because I need help controlling my pain" - even though you should never let myths about 'strength' and 'weakness' ruin your quality of life. Help and relief are possible - but only if you are willing to discuss your pain with a doctor or caregiver.

You don't have to live with severe chronic pain

If your current pain therapy is not providing the relief you want, or its side-effects are upsetting your daily life, you should talk to your doctor. He or she may be able to adjust your medication dosage, prescribe a different medication, or offer you a number of other options.

Your doctor may also refer you to a pain specialist or a pain clinic. Pain clinics are a reasonably new type of service, set up to meet the specific needs of people who suffer from chronic pain. Clinic patients meet with health professionals who have a specialist's understanding of the problems encountered by people experiencing unrelieved pain.

Some pain clinics offer coordinated treatment by a team of health professionals that may include physiotherapists, nurses, counsellors, psychologists and medical doctors. This multidisciplinary approach has evolved as health professionals recognise that chronic pain has wide-ranging effects on your quality of life. A combination of treatments is often the most effective route to improving your well-being.

Initially, your doctor will conduct a thorough pain assessment to determine the intensity, distribution and impact of your pain. The different pain factors each have a diagnostic significance:

  • Pain intensity helps evaluate the degree of functional disability. Changes in pain intensity provide information about the source of pain, psychological factors, and severe structural problems. For example, back pain or leg pain that increases during or right after activity may indicate structural problems. In contrast, back or leg pain that occurs 1 to 12 hours after activity may indicate joint injury.
  • Pain distribution helps locate the pain source.
  • Onset of pain can help identify new or missed pathology, or any psychological factors.

To evaluate the level of your pain, your doctor may ask you to use a visual analogue scale like this:

Visual analog scale

Your doctor will also ask you to describe:

  • how long you have been suffering from pain. (Chronic pain is usually defined as pain that lasts longer than three months.)
  • the relative effectiveness of your current pain treatment.
  • the impact of your symptoms on your quality of life. (Chronic pain is often associated with other problems such as fatigue, depression, irritability, anxiety, disability.)

If your current therapy is not effectively controlling your pain - or is causing uncomfortable side effects - it is important to talk to your doctor about treatment options, and ask to be referred to a Pain Specialist near you.