In the midst of an opioid epidemic, doctor-patient communication is more important than ever
The United States is in the midst of a drug overdose epidemic. According to the CDC, 91 Americans die every day from an opioid overdose; nearly half of those deaths involve a prescription opioid. Prescription opioids and heroin combined killed more than 33,000 people in 2015, more than any year on record.
Finger-pointing and mistrust has erupted among health care experts and between doctors and patients as we face this crisis. Some say doctors are overprescribing opioids. Some say drug-seeking patients are the problem. One thing is clear: successful pain management requires trust and honest communication from all parties. Here’s a look at the issue from the perspectives of both doctors and patients.
A brief look at the problem – or two problems
Regulation of opioid prescriptions and even the statistics on overdoses are controversial topics, debated by doctors and patients alike. Some say opioids are essential for end-of-life care but irresponsible to prescribe for conditions like low back pain and fibromyalgia. Others say that opioids, when used wisely, are the only medications that work and that keeping them out of the wrong hands is the problem. Some argue that suicides should not be counted as accidental overdose deaths.
“If prescription drug abuse is an epidemic, then I think chronic pain may be a pandemic.” – Bob Twillman, Academy of Integrative Pain Management
Without entering into the nitty-gritty details of the debate, most parties will agree that there are two problems at hand, as Bob Twillman, executive director of the Academy of Integrative Pain Management (formerly American Academy of Pain Management) told PBS NewsHour: “I think what we have seen with regulations in this area has been an attempt to find very simple solutions to what is really two complex problems, those two problems being the problems with prescription drug abuse, but also the problem of chronic pain.”
Twillman goes on to say, “if prescription drug abuse is an epidemic, then I think chronic pain may be a pandemic, because the Institute of Medicine tells us that affects over 100 million people in the United States. So I think what we have to do is to find the kinds of solutions that really address both of these problems and don’t wind up giving us what’s essentially a zero sum game.”
For more on this topic, see Top Three Strategies to Help Patients Managing Chronic Disease
Chronic pain: a doctor’s vs. a patient’s perspective
Considering things from both the perspective of a pain doctor and a chronic pain patient shines a light on common disconnects between these two parties, and why communication is such an important factor. Consider these point-and-counterpoint blog posts in the National Pain Report, “the leading online news site dedicated to the coverage of chronic pain.”
The first post was written by Dr. Richard Radnovich, D.O., as advice to patients on how to improve their interactions with doctors. Titled “10 things never to say to your doctor about your chronic pain,” Dr. Radnovich advises patients not to ask for a specific pain drug. “Nothing says ‘drug seeker and abuser’ to your doctor faster than saying the only thing that works is Percocet. You are establishing a relationship and asking the doctor for help; not asking for a specific treatment plan,” he writes.
His other recommendations include not overstating one’s pain symptoms, not volunteering to your doctor that you are not an addict, and not bringing up any diagnosis or treatment you saw on TV or the Internet.
Rather than perceiving patients as drug-seeking, consider that they could be giving you important information – or asking for help.
In response, Kurt W.G. Matthies, a sufferer of severe chronic spine disease for over 30 years, wrote a post titled “How to Talk to Your Pain Doctor.” To Dr. Radnovich’s point about exaggerating one’s pain levels, Matthies writes, “Most pain patients are undertreated and exhausted from living with chronic moderate pain daily. Here they are looking for help, and they want to communicate that their pain is serious. When a patient says ‘my pain level is 12′ perhaps she’s actually saying ‘please help me doc. I can’t take it anymore.’”
Rather than treating the patient with suspicion, the better response is empathy.
As for not asking for a specific drug, Matthies writes, “Why not? I’ve been prescribed opioids for 25 years, daily. I know that OxyContin in ‘safe’ doses does little for my pain … However, I respond well to hydrocodone, methadone, and morphine. Shouldn’t the doctor know that? It’s in my chart. [And] in my experience, a doctor hasn’t read my chart during a first visit.”
This underscores the importance of truly listening to the patient. Rather than perceiving patients as pushy or drug-seeking, consider that they could be giving you important information about their medical history. Of course, if you suspect the patient is not being forthcoming or is not adhering to treatment plans, there may be another issue at hand.
For more on this topic, see How to Handle Difficult Patient Conversations
The link between effective communication and pain management
Effectively managing patients’ pain starts with dispelling some common myths about pain (admitting pain is a sign of weakness, all pain medicine leads to addiction). It continues with educating patients on the options available to help them, and teaching them how to safely and consistently follow the treatment protocol you decide on together.
Studies show patients who experience better communication with providers are better able to manage their pain.
Rather than treating all pain patients with suspicion, open up a dialogue about how everyone experiences pain differently, whether or not pain should be expected and if so how much, and the best way for patients to accurately communicate their pain levels to you or another provider. Studies show that communication and trust within the doctor-patient relationship are key pieces of the pain-management puzzle.
In 2015, the Virginia Hospital & Healthcare Association published data showing the link between effective communication and pain management. “There is a direct relationship between how patients score their communication about medication and their pain management. This suggests that as patients experience better communication with caregivers, they are better able to manage their pain.”
As chronic pain patient Matthies writes, “You docs may have the clinical experience – no argument there – but we’re the experts on our pain until you decide to gain that expertise. It’s a long process that requires trust and mutual respect.”
For more information on safer prescribing, see the CDC’s Guideline for Prescribing Opioids for Chronic Pain, released in March 2016.
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