I think I speak for many medical practitioners in saying that a sinking feeling often accompanies the presentation of patients who describe chronic or persisting pain. The patient's agenda is usually quite clear from the outset and becomes apparent with an opening line that often goes something like: 'please would you give me something better for my pain'. By this stage, patients are often already feeling quite defeated by relentless pain and understandably are after a solution that works quickly.
As a practitioner shaped to be patient-centered and intrinsically striving for the alleviation of symptoms, it is often all too easy to reach for medications that you know can lead to poor outcomes in the long term. Using drugs as central in a management plan for persistent pain may meet patient expectations but is not without consequence. Perceived reliance upon these medications to remain 'pain free' is often the start of a vicious cycle culminating in physiological tolerance and dependence on drugs. This is not to mention the host of side effects which commonly accompany short or long term use of many strong analgesics.
Without adequate services dedicated to comprehensive persistent pain management in rural areas, patient care too often is centred around drugs. It is difficult as a rural practitioner to have discussions with patients about evidence-based multi-disciplinary approaches to persistent pain management when you know that the services are just not that available.
When a patient is in front of you visibly suffering, hearing that the best approach to their pain management involves going on a long wait list for a comprehensive pain service is just not what they want to hear. For geographical reasons and the necessary travel involved, accessing these kinds of services which often are based in larger centres is simply not feasible for many patients in rural areas.
I am involved with the Pain Revolution to help empower health professionals like myself to engage their patients in good evidence based management of persistent pain. The first essential step is to better understand the neuro-physiology and psychology of persistent pain and I'm privileged to learn from and educate with world leaders in this field who are part of the Pain Revolution. We can only be effective in shifting patient expectations of persistent pain management if we as health professionals are confident in our understanding of the evidence and have ways to advocate for a more holistic approach that will engage rather than dishearten our patients.