Wednesday, November 23, 2011

Family Medicine: Pain is a Ten Point Game

Pain Pseudo-Factoids from a prescription pad holder (physician):

1.  No Brain, No Pain

2.  Pick the right parents, or have more pain (and more risks with opiates- for dependency, misuse or abuse)

3.  If your pain is a ten out of ten and you are not writhing, doctors won't believe you

4.  If your pain is an eight out of ten and you grimace, doctors will probably believe you (see migraine exception #7 and Fibromyalgia Factoid #13)

5.  If you get IV Morphine or Dilaudid in the ER and your pain loses 4 points or more (e.g., 8/10 drops to 4/10 or less) and you so state, doctors will usually believe you (if you say "thank you" to the doctor)

6.  If your pain is a six, you should get at least 2-4 points less with hydrocodone/acetaminophen (Vicodin type generic), surprisingly to opiate fans- Ibuprofen 800 mg has equal pain killing potential for those who picked the right parents (see #2)

 7.  If you have migraine headaches (who decided to use the word ache instead of pain?, by the way made a huge mistake) and smile when you tell the doctor your pain is an eight, they will believe you if they or a close relative have migraines

8.  If you require huge amounts of dental "numbing" injections when you have a filling at your dentist, you may have picked the wrong parents (see #2)

9.  If your pain is a four in the doctor's office and a six at work or while carrying your baby, inform your doctor of the pain level variances to help them understand your pain range.

10.  Pain never stays at the same level continuously in the medical world.  If you give a doctor a range for your pain variation, you are speaking our language and we hear you better.

11.  At every doctor visit for chronic painful conditions, be prepared to deliver your pain numbers on a scale of 0-10, which more and more has to be written into any note that involves prescriptions of opiates and other pain killers.

12.  The fear of the pain may be equal to or greater than the impact of the pain on the pain sensations.

13.  If you have Fibromyalgia, 50-75% of physicians will be confused about how to respond to your pain  comments. (it used to be 99%)

14.  Blogging about conditions that include a chronic pain element helps the medical community to get a better understanding of what  life and activities are like with chronic pain. Thanks to all you bloggers with chronic painful conditions.


  1. Interesting read. I didn't understand the reasoning behind #13.

    RE: #6 Steroid Withdrawal is a 6/7 for me and I can get it down to 4/5 alternating Tylenol and 800mg of Motrin. No narcotics necessary!


  2. Thanks for your comment MM. Yes steroid withdrawal can hurt. Sorry to hear you're an expert at it. #13 is about physicians being spooked by the "F" word-Fibromyalgia. The mystery and uncertainty scare many physicians when we should desperately seek to understand it. Part of the paradox of pain. APJ

  3. Ah okay. Thanks for the clarification. I feel bad for Fibro patients, they seem to be the F word of medicine. I guess since I've been poo-pooed with the adrenal stuff, I am sensitive to others being ignored.

    PS: I still would like help (other than narcotics, maybe muscle relaxers?) for the withdrawal since mine goes on forever and after about a week I'm crying by 5pm. But pain mgmt is not on the agenda for HPAA suppression. I am working on a post to talk about that.


  4. I have several chronic pain conditions, chronic pancreatitis, 2 frozen shoulders, etc. I also blog about it. I'm incredibly grateful to my pain management doctor.
    I also blog about it. Do to an over active imagination my pain is never a 10, an 8 when it's really bad. Since seeing pain doctor it's usually a 4 or 5. I can live with that I don't expect a pain free life.
    I look at my pain meds as a tool that allow me to participate in my own life. Through them I can do things I never imagined doing.

  5. I really enjoyed reading is g your post. Thank you for sharing so nice and helpful ideas to readers who do not have to face this problem again in their project

    Carl Balog

  6. Happy reading this post, at least I have ideas whenever I go to my doctor. I relate to number 3 and 4, lol. Some of patients have the exaggerate explanation of pain. Aside of visiting My doctor I also visited pain management Brooklyn almost every week.