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One Doctor's Opinion: The Stigma of Neuropathic Pain

  [ 534 votes ]   [ 6 Comments ]
By Dr. J C • • April 3, 2007

Posted online 3/14/07 by the Global Neuroscience Initiative Foundation at GNIF Brainblogger.* Used with permission.

In my work as a physician, one thing that has always bothered me is the patient with 'neuropathic pain'. Here is the typical scenario:

A patient with a history of chronic pain (usually back pain) and pain medication use comes to the hospital for surgery. Post operatively, the patient’s pain is poorly controlled, despite administration of high doses of morphine derivatives. On examination the patient is extremely tender to touch, in areas remote to the operative incision. Both the medical team and surgical team are uncomfortable administering higher doses of medication. They prefer to consult the pain management team, referring to the pain as 'neuropathic'.

In the medical profession, we are bothered by patients with neuropathic pain for several reasons.

Most obviously, we get frustrated that we can’t make them feel better. Despite high doses of medications and bedside counseling, we can’t seem to ease their pain.

The main reason we are frustrated is that our mission is to make people get better. We tend to overlook the simple fact that pain is a subjective phenomenon. What is painful to one person may not be as painful to another. When we administer high doses of pain medication to no relief, we get suspicious of our patients as drug seekers. We don’t want to promote drug seeking behavior, despite not really knowing what it is like to have uncontrolled pain.

Perhaps the worst thing about medicine is that once this term makes it in a patient’s chart, it follows him or her forever.

The stigma associated with having chronic pain issues can considerably alter a patient’s pathway of care. Doctors tend to shuffle problematic patients to those providers that are capable and willing to participate in their care.

Most of the health care providers I have dealt with who are comfortable with neuropathic pain patients are pain management specialists, neurologists, rheumatologists, and physiatrists.

Unfortunately, the rest of us seem to perpetuate this stigma throughout the health care system.
* The “open-access” site is sponsored by the Global Neuroscience Initiative Foundation (GNIF), which describes itself as “a non-profit charity organization for the advancement of neurological and mental health patient welfare, education, and research. We aim to further brain related studies, end stigmatization and discrimination, improve the well-being of afflicted individuals, promote the free and open-access distribution of brain related information, and institute universal and multidisciplinary distance educational programs.”

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Article Comments Post a Comment

Response to Dr. J.C.
Posted by: crashcart
Apr 4, 2007
Dear JC, Thank you for your candid statements regarding chronic pain patients. As a nurse with ER experience, wound care experience, several years in post-op recovery and as a chronic pain patient myself I know the complexities of this problem very well from "both sides of the railing". I also know, as you pointed out, that not every practitioner is appropriately suited, emotionally or psychologically, to treat every problem that comes his or her way despite our desire to do so, and our professional "obligation" to do so. We must, as professionals, realize when to step out of these situations for the good of the patient...the sooner the better. And if you are in a position to teach this to others please do so. You will go a long way in helping many patients avoid a lot of time lost, and a lot of anguish, frustration, anger, humiliation, bewilderment and self-blame not to mention a lot of ill-spent money. You will also be doing your colleagues a favor in sparing them the notion that they *have* to treat these patients. They are doing the absolute BEST thing they could possibly do when they refer that pain patient to the nearest pain clinic. All it takes is a few minutes of their time to look up the address and phone number. Or have their staff do it. Or if they are in a busy ER setting and time is a problem, do a social work referral and let *them * take care of hooking the patient up with the right people. In these cases you're doing them a favor to "turf" them because they certainly don't need to be seen by people who are going to put them in that little box of names with "Drug Seeker" on it. More often than not, what they really need is for someone to just listen to them...really *listen* and give them some feedback. And doctors just don't do that. That's why reputable pain clinics have psychologists on staff, as well as other ancillary team members in order to meet the patient's holistic needs. Just throwing more meds at them is not enough with chronic pain pt.'s. It's not a "treat 'em & street 'em" problem and health personnel who are in it with that type of attitude would do everyone a favor by just honestly referring the chronic pain pt. right at the outset to someone who is a more appropriate practitioner. BTW, there are Holistic Nurse Practitioners who do very well with this type of patient. Again, I thank you for sharing your thoughts and thereby letting patients know that not all doctors are appropriate for *them*. Respectfully, Lynn M. Waugh l
Reply Reply

Stigma of Neuropathic Pain
Posted by: AuntieLin
Apr 4, 2007
As one who deals with chronic pain, I found this article and the reply by Lynn Waugh very informative and helpful. I have periphreal neuropathy, fibromyalgia, and arthritis. The intensity of pain is up and down, but never gone (pariticularly with the neuropathy). Fortunately, my internist is wonderful and very understanding -- I don't believe he sees me as a "drug seeker." As well, I see a neuoroligist and rheumatologist.

One of my problems is that I need surgery, unrelated to any of my conditions. I think I keep putting it off because I am terrified of waking up and being in great pain from the neuropathy, and no one doing anything about it! The medication I take for that needs to be evenly spaced out to keep the pain under control. Having missed a dose now and then, I am fully aware of how that greatly increases my pain.

The other issue about folks with chronic pain is that it doesn't "show" to other people, so they tend to not acknowledge it, or to forget that it's with you all the time (even family members).


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