Common Challenges in Treating Chronic Pain (for Professionals)

Challenges in Helping People with Chronic Pain

Q&A

I recently asked the health professionals in our audience a question. I wanted to know – how many of them look after people in chronic pain – and what are the challenges they face?

The answers were very interesting. They’re interesting if you’re a health professional. They’re also useful if you’re trying to get out of chronic pain. Because they give insights into what holds people back from making the most of the help they can get. And they show how to better help people.

I’ve been running a chronic pain clinic for over 14 years, so I’ve come across many of these challenges before. It was fascinating to find out how other practitioners are handling these challenges. And that’s what I’d like to explore here.

The first question was: how important is treating chronic pain in your practice? I was surprised at the answer.

The average level of importance health professionals placed on chronic pain in their practice was 8.85 out of 10.

Now – there are a lot of challenges in treating chronic pain. I know this first hand – both from having chronic pain in the past and treating it. It’s not an easy field. But it can be very rewarding.

Top Challenges in Treating Chronic Pain

“It’s hard to teach people about sensitisation so they don’t think ‘it’s all their fault’ or ‘it’s all in their head.’”

This was a very insightful comment. It’s vital people understand about pain sensitisation (or ‘amplified pain’) because then they realise how much more control they have over their pain. It empowers people to practice self-treatment techniques. And it reduces anxiety (which then reduces pain.)

The challenge lies in how you introduce this concept. Over the years I’ve gotten better at this. I’ve learned to explain the concept that ‘not all pain equals physical damage’ in many different ways. I’ve used technical language to explain this to engineers, electrical language to explain it to electricians, visual language to explain it to visual people.

Because I know when people really ‘get’ this, they walk out of my consulting rooms with a whole new way of thinking and acting. And this new approach means they’re able over time to turn down their pain and return to normal life.

“It’s tough getting past the ‘give me a pill and fix me’ mentality.”

This is massive. Unfortunately, as a doctor, I can only do so much to change someone’s mindset. They have to arrive ready to do the work as well. However, many of the people I see have already tried many other treatments – all the way up to having surgery. And when they still have pain, often they’re open to taking charge of their health and actively

You need to be able to recognise how ready people are to step up. The people who are ready – you can work with them in one way. When people aren’t ready, there’s other things you can do to help them until they are ready. This removes the stress of trying to push people into a place they don’t want to go (even if it’s in their best interests.)

“Chronic pain is often complex. It takes time to untangle all the different aspects of the problem.”

This is 100% true. I often say ‘if it was simple, then you wouldn’t still be in pain.’ There’s often several factors you need to look at to make progress.

However, over the years I’ve found 6 key areas to look. And you only need to start with one at a time. It’s like untangling a knotted ball of string. You just need to find one free end to begin with. And as long as you keep working away, you will in time untangle the whole thing.

“It’s a delicate process getting patients to consider the psychological component of their pain.”

If you’re not careful in how you do this, your patient may think:

  1. You don’t believe them when they say they’re in pain
  2. It’s their fault they’re in pain
  3. They’re somehow ‘inventing’ the pain for secondary gain

It’s important to address these issues properly if you’re going to make progress down this path. Looking at the psychological aspect of chronic pain is something I’ve found to be incredibly powerful and transformative. But only if it’s handled correctly.

I have a lot more to share on this topic – which I’ll do in Part II. First though – I’d like to know your thoughts.

Just leave a comment below and I’ll answer any comments or questions you have.

Have you encountered any of these challenges before? How did you handle it? Let me know in the comments below…

Want to continue? Here’s Part II >>

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(8) comments

Carol Newton March 27, 2017

As a patient, I see now that my doctor wasn’t able to explain to me that I was on the road to chronic pain. He sent me to a pain management centre but I didn’t go because I didn’t see the point right at the very beginning in 2013. I wish he had made it clearer. I had no idea where I was heading. All he wanted to do was put me on anti-depressants and I resisted that. Negotiated with him to take St John’s Wort and go to counselling. I wasn’t depressed, I was distressed. He helped in some ways, but wish he had explained
everything more clearly. To him the answer was anti-depressants. Unfortunately, the psychologist I went to see was too young for me and didn’t help. A rheumatologist he referred me to said it was soft tissue, and a neurologist gave me facet joint injections which made the pain much, much worse.
I realise I have some responsibility for the ongoing situation., however,
finding a good fit is important for health care.
I have battled it out myself mostly, since then, however, over the time I have found health care people I can trust. That is very important.
Hope this is useful for you from a patient’ s point of view.
Thanks

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Murray March 27, 2017

I would have to agree with all of the respondants answers you listed above. It certainly is a delicate procedure delving into the process of chronic pain. It does require talking and reading patients in order to become effective in helping them sort their way out of chronic pain .

Wouldn’t it be nice to have a fail proof protocol but I suspect that no two patients are alike and flexibility to work with the sufferer is a key ingredient.

Cheers
Murray

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Murray Woods March 28, 2017

1. It is not so much the message, but rather the way the message is presented. Not only are these patients’ nervous systems sensitized, but their personality sensitivities are also sensitized!! We never run out of the need to devise new and better ways to engage the chronic pain patient… in committing to trying to tackle the problem a new way. The Prochaska and DeClemente change model from 1983 is an excellent screening tool to help select out those patients who are really interested in a long lasting change versus those who are simply kicking tires. Often there will be the need to work with medication reliance/addiction, again in a partnered way with meds free being the goal. In the case of the dual diagnosis patient, there can be the need for shared care, eg with a psychologist, psychiatrist or addiction counselor. But having an involved and proactive GP as the quarterback for this team, where information gets shared, is the most effective approach, in my experience. The practitioner who cannot suspend his or her own judgement in managing chronic pain patients does not do well with this group. Patients are very quick to pick up on this.

2. A chronic pain practice does not fit the typical fee for service model, but rather requires more time per patient. Multidisciplinary teams have become the norm in Canada, where several providers are under one roof.

3. The central sensitization notion is indeed empowering, as it implies there is the potential for control and downregulation of pain inputs.

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Linda March 28, 2017

I also agree with the above comments. I’m a health professional who has been dealing with my own chronic pain for 28 years. Over the years I’ve heard many explainations of central sensitisation. For me Jonathan’s is the clearest. Many of my clients agree and have gone on to buy your book. Thank you

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Steve Sharples March 28, 2017

As a health care professional (orthopaedic physio specialist) l have reflected on my practice constantly having trained with essentially a bio medical model approach l knew this was only part of the puzzle but working in pain clinics and acknowledging psychological/social factors and Ace adverse child experiences Factors and resilience this gives you a much more holistic approach to enable.the patient to take control

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loretta March 28, 2017

Hi Johnathan well I am a therapist and have.fibermialja myself it’s like living in a nightmare.I have all your course info and still get so lost and frustrated.and every day is a struggle.. I have this pain for 50 yrs have tried everything know a lot but still feel helpless.I don’t have the energy sometimes to even open my tablet .Sorry for moaning x

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Heather Wolf April 27, 2017

First of All, I want to thank you from the bottom of my heart for writing this book and for leveraging your case to bring about some great strategies out of pain. I purchased your book on Amazon as a suggestion after having read many books on neuroplasticity and reducing pain by reiring your brain. Your work is some of the best I have come across over the 6 years since breaking my neck and living with chronic debilitating destructie pain. I have CRPS/ aka RSD aka Causalgia.
After breaking my neck (c6 fascet fracture) in a sporting accident in 2011 I went in for a quick microsurgery to free up my c6 nerve as the fracture didn’t heal properly. There was a tragedy in the operating room and the neurosurgeon gave me the wrong operation- a DDD surgery from c4-c7 and it looks like an intern did the operation as he severed almost the whole of my dorsal root ganglion at c7. The surgeon went on to pretend he had done the correct surgery and it wasn’t until i could not heal from the botched laminectomy 8 months later that i got a post-op MRI and found that i not only did he give me the wrong operation but he didn’t finish it by installing supportive hardware and he gave me a massive neuronma. I would need another operation to fully stabilize my spine with vertebrectomy and 3 level fusion, but the severing of my dorsal root ganglion was perhaps the worst mistake becuase as you know this is inoperable. That mistake gave me causalgia aka Chromic regional Pain Syndrome type 2. After receiving a spot-on reconstructive surgery by one of the leading neurosurgeons in the world and getting a stem cell transplant to aid in helping heal myself, the Causalgia lingered on and on and on. I traveled all over the world to find a cure, to find something to help me. I tried almost every therapy and treatment undergoing psychotherapy to identify any childhood traumas or triggers- and the pain persisted. The treatment regiments were eclectic and required full mind body connection. Much of what you describe was helpful to turn the level 10 pain down to a 7 or 8 by conventional cycles. Despite my active pain generators which i cannot turn off due to changes in my sponal cord I have laid focus again on somehow being able to reprogram my brain by telling my brain to turn down the volume of the neuroma- that it shouldn’t listen to that pain signal. The neuronoma which developed at the dorsal root ganglion has greatly impacted my ability to step out of the pain cycle. My question to you is- can you envision a way to exit the sympathetically mantained pain cycle when you have an inoperable active pain generator? We have tried shooting the neuroma with botox, sympathetic blocks, trigger point injections, transcendental meditation, you name it. I am deeply interested in using my experience like you to help others and have created a foundation with my pain doctors to CURE CRPS. We are going live with the Foundation in June of this year and I would be honored to have your help in leveraging my case study to determine a path to successful outcomes. Can the body somehow heal a neuroma at the dorsal root ganglion?

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