Chronic Pain Treatment Often an 'Imperfect Solution'

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Assessing patients is the foundation of pain treatment, including obtaining information on duration, frequency, and severity of pain.
Assessing patients is the foundation of pain treatment, including obtaining information on duration, frequency, and severity of pain.

The desire of healthcare providers to come as close as possible to providing the “perfect” solution—completely relieving their patients' chronic pain—may set the stage for unrealistic expectations of pain treatment. 

These unrealistic expectations could, in turn, lead to patient frustration, lack of adherence to treatment plans, and other nonproductive or negative outcomes, according to Kevin L. Zacharoff, MD, of PainEDU.org.

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“Thinking about chronic pain treatment as more of an imperfect solution, and one that in many cases may be a negotiation instead of a one-way outcome, has the potential to help patients and healthcare providers look at chronic pain treatment as an ‘aim high but shoot low' perspective,” Dr. Zacharoff said. 

A significant amount of attention is being paid to helping clinicians avoid the paternalistic approach in managing chronic pain and instead employing a shared decision-making approach, one that is calibrated with realistic goals and expectations, Dr. Zacharoff explained. 

Assessing patients is the foundation of pain treatment, including obtaining information on duration, frequency, and severity of pain. However, there are no objective tests that can quantify pain quality and intensity, so assessing pain largely becomes a “subjective experience.”1

There is also much that has been written about what Dr. Zacharoff termed “magic solutions,” or those solutions that offer people “complete relief.” He urged clinicians to counsel their patients and help dispel these “complete relief” claims. 

“You want to avoid setting up the situation for unrecognized goals, frustrated patients, and the healthcare provider carousel, where patients go from one clinic setting to another because of unrealistic and underachieved goals,” he cautioned.  

The way to avoid setting up unachievable goals is simple, Dr. Zacharoff said: “Don't make promises that you can't keep. Or that others can't keep. Or that people want you to keep. Or that you don't know you can keep.” 

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