The Five Rules of Pain in the World According to Me
1
Pain Doesn’t Exist
Pain is a description, it’s not a reality, you can’t see, touch, feel, or measure pain. When in fact, the most accurate representation of pain is by the patient’s own description. Hence the scale, one to 10 out of a desire, and an inbred scientific desire to have something more objective than subject. It is not. It is you, keep it that way.
2
You Must Have a Diagnosis
Low back pain is not a diagnosis, for example. Low back pain is a symptom. Degenerative spinal disease that is supported by clinical documentation or findings by physical exam, history, et cetera, is a completely different picture. So diagnosis is important, but it doesn’t drive the visual analog scale. This is you looking at the line and placing your pain on a scale of 1 to 10, one being almost inconceivable, 10 being almost unlivable pain.
3
If You Don’t Believe in a Diagnosis You Can’t Treat the Problem
If you don’t believe in a diagnosis or you think it’s entirely psychosomatic, you can’t treat the problem. This is the old fibromyalgia where people think it, therefore it was, and even though you couldn’t see, touch, feel, or measure the pain of fibromyalgia, that being widespread, it truly exists. As science marches on we understand it better, fibromyalgia is real, the pain is real, and we may have that comment as above, the most accurate description we have of pain is self-report.
4
Know Thy Meds
I believe that a practitioner that treats pain should have five classes, and five deep on the actual drugs. Easy to do. And in two months memorize another five under those classes, expand the classes if you need to. What is a class? A class is like anti-inflammatory medications, opioids, muscle relaxers, gabapentinoids, I think you get it. For the type of practice and the type of patients the practitioner sees they pick that defining parameter.
5
I Want to Improve Your Function
Number five and the most important of all, is that from a desirable standpoint I really want to treat your pain and make you all better. From a realistic standpoint, I want to improve your function. No more so does this matter than the VAS or visual analog scale here. Rule five tells us if we’re doing better where you couldn’t sit very long or play with the grandchildren, even go to the grocery store or sit in a car for 30 minutes, after treatment, therapy, or whatever it might be you may have doubled that. This is where journaling, and discussions with your healthcare provider point the direction where everyone wants to go. To your best outcome.