The Stigma of Neuropathic Painby JC, MD | March 14, 2007
In my work as a physician, one thing that has always bothered me is the patient with “neuropathic pain”. Here is the typical scenario:
A patient with a history of chronic pain (usually back pain) and pain medication use comes to the hospital for surgery. Post operatively, the patient’s pain is poorly controlled, despite administration of high doses of morphine derivatives. On examination the patient is extremely tender to touch, in areas remote to the operative incision. Both the medical team and surgical team are uncomfortable administering higher doses of medication. They prefer to consult the pain management team, referring to the pain as “neuropathic.”
In the medical profession, we are bothered by patients with neuropathic pain for several reasons. Most obviously, we get frustrated that we can’t make them feel better. Despite high doses of medications and bedside counseling, we can’t seem to ease their pain.
The main reason we are frustrated is that our mission is to make people get better. We tend to overlook the simple fact that pain is a subjective phenomenon. What is painful to one person may not be as painful to another. When we administer high doses of pain medication to no relief, we get suspicious of our patients as drug seekers. We don’t want to promote drug seeking behavior, despite not really knowing what it is like to have uncontrolled pain.
Perhaps the worst thing about medicine is that once this term makes it in a patient’s chart, it follows him or her forever. The stigma associated with having chronic pain issues can considerable alter a patient’s pathway of care. Doctors tend to shuffle problematic patients to those providers that are capable and willing to participate in their care.
Most of the health care providers I have dealt with who are comfortable with neuropathic pain patients are pain management specialists, neurologists, rheumatologists, and physiatrists. Unfortunately, the rest of us seem to perpetuate this stigma throughout the healthcare system.
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