A Mass General expert offers tips on how to improve patient-doctor conversations about chronic pain.

Talking to your healthcare provider about chronic pain can be difficult, but it is a conversation worth having, says Paul Arnstein, PhD, a Massachusetts General Hospital nurse and educator who has 35 years of experience in pain management.

Doctors can’t apply a pain monitor, like they can to check your blood pressure. “Healthcare providers will not know the location, timing or intensity of your pain, unless you tell them,” he says.

Paul Arnstein, PhD
Paul Arnstein, PhD

Dr. Arnstein has helped many patients and also works with professionals and lawmakers to improve pain management. His research is exploring ways to better evaluate chronic pain. He is also studying how to use nondrug relief methods to reduce the need for opioids and improve the training of health professional students.

For cultural or religious reasons, patients often downplay pain. Doctors may ask about pain, or delegate the task. Dr. Arnstein remembers going to the doctor after a painful injury. An assistant gruffly asked, “You’re not having any pain today, are you?”

“It’s that tone and type of question that often silences patients,” he says.

Starting Conversations About Chronic Pain

When patients hesitate to discuss pain with their doctors, it creates a barrier to treatment. That is especially true if a patient is dealing with chronic pain, which is pain that lasts three months or longer, Dr. Arnstein says.

In America, an estimated 116 million Americans live with chronic pain. Chronic back pain is the leading cause of disability worldwide; with head or neck pain, arthritis, nerve damage and cancer pain also very prevalent. But despite how frequently pain is the reason that patients seek health care, in-depth conversations about pain and its impact rarely occur between providers and patients, Dr. Arnstein says.

How Patients Can Help

Dr. Arnstein suggests that you write down the description, location and intensity of your pain and note how it changes over time. Bring those descriptions and how it affects your daily activities along with the three most important questions you want to ask your medical provider to your appointment.

He suggests avoiding telling the doctor vague descriptions, like “‘I hurt all over. I can’t do anything. I can’t deal with it.’” These descriptions do not help identify a treatment and may use valuable time during a short visit, he says.

Be specific and talk about your pain in a calm manner to work with your doctor to find a treatment.

But, by being specific, and saying, for example, “’I have strong shooting leg pain that’s worse at night and prevents me from sleeping,’” the patient can help a health provider, Dr. Arnstein explains.

Chronic pain often triggers emotions like sadness, fear or anger, he says. Because chronic pain usually can’t be eliminated, frustration mounts — particularly if professionals appear unsympathetic.

These emotions can interfere with clear communication and working with your doctor to develop the best treatment plan. Talking about your pain in a calm manner is a challenge, but worth the effort. Be firm, but not demanding, and do not silence yourself when you have a concern. Speak up, Dr. Arnstein advises.

The good news is there are many medical, surgical, mind-body and physical therapy-based treatments for pain, as well as complementary approaches such as yoga and acupuncture. Several approaches are often needed to gain the best relief.

Research also shows that patients with an optimistic outlook get better pain relief. So never lose faith that you will feel better, even if the pain persists, Dr. Arnstein says.

Tips for Talking With Your Doctor

Before you go:

1. Think about what you want from your doctor.

Do you want analysis?
Question: Are there scans or tests to better diagnose my condition?

Do you want information?
Question: What causes my pain?
Question: Does my daily diet, exercise or sleep pattern help or worsen the pain?
Question: What are the pros and cons of available treatments?

Do you want advice?
Question: What treatments do you think are best for me?
Question: Are there things in addition to medical treatments that could help?

Do you want reassurance?
Question: Will you continue to work with me to find the best treatment for me?
Question: Will you tell me if you think another treatment or second opinion may help?

2. Create a list of the questions you want answered.

Review the list before your appointment. Revise to form the three top questions you want answered. Practice asking the questions with another person to test their clarity. If possible, include words that reflect what you want (advice, analysis, etc.) identified above.

3. Bring notes about your pain.

Be able to clearly describe its location, intensity, changes over time, and how it affects your life.

4. Be assertive, but don’t blame healthcare providers.

They cannot feel your pain, so you need to communicate clearly and work together for a solution. If your questions are not answered, ask for a follow-up appointment or email to get the answers you seek. Referrals to other providers may be needed to help you think, feel and do as well as possible despite ongoing pain.

To make a donation to support Dr. Arnstein and other Mass General researchers, please contact us.