How Do You Define Pain?
A UHealth specialist asks patients to rethink their relationship with chronic pain.
If you live with physical pain, you might object when Dennis Patin, M.D. says it is a natural part of life. Don’t shoot the messenger – Dr. Patin truly wants to help.
“Pain is one of the most common symptoms patients experience. However, one-third of patients have pain because they were never sent to a pain management specialist. I give hope to patients who haven’t had hope.” Dr. Patin is a board-certified pain management specialist, anesthesiologist, and founder of the accredited pain management program at UHealth and the Miller School of Medicine.
Acute pain and chronic pain: what’s the difference?
“Acute pain serves a purpose. It tells you something is wrong. When properly diagnosed and treated, it goes away. If pain persists three months after a procedure (or injury), it is considered chronic pain, which is a disease unto itself,” Dr. Patin says.
Chronic pain motivates patients to seek out specialists like Dr. Patin. Typically, by that time, they had been to multiple doctors and had multiple procedures.
“After two or three spine surgeries, for example, you know the procedures aren’t effective,” Dr. Patin says.
Although there is a wait for appointments, once a patient is in Dr. Patin’s exam room, there is no rush. “I spend a long time listening to patients.”
He becomes a “detective” of sorts and often finds that patients were misdiagnosed, leading to “one problem becoming another.”
How pain affects our thoughts
While speaking with patients, Dr. Patin may find a connection between physical discomfort and emotions. When an individual says they hurt all over, Dr. Patin’s “antennae” goes up, prompting him to ask if they have experienced traumas in life.
“Psychic problems turn into physical problems such as a somatization disorder that never gets diagnosed.” People with somatization disorder tend to be overly anxious and preoccupied with their physical symptoms, even mild ones.
To illustrate how strongly our nervous system influences our perception of pain, Dr. Patin uses the example of phantom limb pain. “The limb is gone, but the nervous system retains the memory. Pain exists in the nervous system, not in the body part.”
Patients and physicians must work together, he says, to manage the patient’s anxiety and the tendency to perseverate.
“The more they pay attention to the pain, the worse it becomes. The more you legitimize something, the more real it becomes. Pain is not just a symptom in the body; it is a symptom in the mind.”
He urges patients to address the psychological component of their discomfort.
“I ask them, ‘Do you think of yourself as healthy or sick? If you think of yourself as sick, you’ll never be well. If you think of pain as the enemy, you want to kill it.
“You don’t cure diabetes or HIV. You manage it. It’s the same with pain. You may not be cured of this condition, but you will be able to live with it.’”
As important as understanding a patient’s medical history is, Dr. Patin doesn’t fixate on the original cause.
“One of the most common misunderstandings people have about pain is that there must be a cause. They search for a cause and bring in a stack of MRI (reports) or think they need another MRI.”
In many cases, the answer is not there. The root cause is even harder to discern in older patients who typically have multiple issues contributing to their symptoms.
Physical therapy is another challenge some patients face, especially those looking for a “quick fix” to relieve their discomfort.
“Often in rehab, when people encounter pain, they stop. Doing physical therapy without steroids (or other pain relievers) is better because if you short-circuit the process with a pill, it perpetuates the pain.”
Opioids are another example. Even when patients should taper off opioids or avoid taking a higher dose, Dr. Patin can encounter pushback. “At some point, opioids make people worse. I tell them, ‘If I gave a pain-free person opioids and then took them off, they would experience pain from the withdrawal.’”
Focus on improved functionality and quality of life.
When performing a “holistic assessment,” he evaluates the physical symptoms, but also mood, sleep quality, mobility, and ability to function. Even if a treatment doesn’t vanquish the hurt entirely, it may help the person get a better night’s sleep. In that case, it’s successful.
“A physician must ask probing questions. If a patient says their steroid shot wasn’t successful because they’re still in pain, I’ll ask, ‘How did you feel an hour after the shot?’
“If they experienced relief, it was successful. If a procedure is successful, don’t abandon it, follow it,” Dr. Patin says.
When it comes to treatments, he has several tools at hand.
- Conservative methods include physical therapy, acupuncture, and counseling.
- Medications include cannabinoids, specialized opioids, steroid injections, and epidurals.
- Some patients with severe pain experience relief after a medically induced, temporary ketamine coma to reset their nervous system.
- Neuromodulation medical therapies help override pain signals from the brain to the nerves.
Every pain management modality, except spinal surgery, is within Dr. Patin’s wheelhouse.
Pain management is a journey, not a destination.
A key component of pain management is sticking with the same provider. “Continuity of providers is important.” There are exceptions. “If a provider has given up on you or you have given up on them, change providers,” Dr. Patin says.
Pain management is a skill based on science and the art of listening, perceiving, and a willingness to think outside the box.
“Our profession is slowly progressing toward functional medicine. It is not evidence-based like treating hypertension. And pain management research is underfunded compared to other diseases.” Still, he continues researching and seeking innovative answers for an age-old problem.
Being able to tell a long-suffering patient, “I can help you, and let me tell you how,” makes it all worthwhile.
Nancy Moreland is a regular contributor to the UHealth Collective. She has written for several major healthcare systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.