Silent Suffering

By Ian K. Smith, M.D.

"Ouch, that hurts!" According to a new Gallup survey on pain, almost 90% of Americans age 18 and older utter those words at least once a month. Equally troubling, fewer than half (43%) of respondents report that they have a "great deal of control" over their pain. That means many Americans are just grinning and bearing ordinary aches and pains, hurting as never before. But I can assure you, from my own experience with sports injuries, this doesn't have to be. Most of our aches and pains are treatable, but only if we're willing to talk about them candidly and accurately with our doctors. That isn't happening. For reasons not well understood, Americans are reluctant to step forward and talk about what aches them. The survey showed that almost two-thirds of adults either ignore their pain or deal with it in their own way, visiting a doctor only if they can no longer tolerate it.

When people do ask me what they can do about their pain, I always tell them to keep a precise record. Indeed, a little homework can help you get the most bang for your buck in the doctor's office in this era of hurried managed care.

You should be prepared to spell out quickly and tersely the key characteristics of your pain: 1) Identify precisely where it hurts and whether the pain moves from one area to another. 2) Describe how frequently you experience episodes, including the time of day they occur and whether they're constant or wavering in intensity. 3) Describe not only the severity but also what the pain feels like (throbbing, gnawing, stabbing), since even seemingly trivial details can help a doctor make a diagnosis. 4) Remember the sort of things that trigger the pain (the type of movement, for example) and whether rest or exercise relieves it. Certainly, tell your doctor whether you've had any treatment before and if it made a difference.

You've got to get the doctor to speak up as well. A new national program titled Speaking of Pain, organized by the Arthritis Foundation and four other health organizations, provides some useful tips on how you can do that. Don't just quietly accept any treatment prescribed. Instead ask what other options might be available. Also, make sure you're told about the side effects as well as the benefits of any therapy.

Many conditions, like the strained muscles I've experienced, will heal on their own, but it's important to know what activities should be curtailed to avoid reaggravating them. Don't be overly concerned if your doctor prescribes morphine-derived opioids, such as Dilaudid or Percocet. They're in the most effective class of pain relievers around. Some doctors have been reluctant to recommend them for fear of contributing to addictions, and, as a survey of minority neighborhoods in New York City showed last week, inner-city pharmacies are less likely to carry them than are pharmacies in white areas. But the fears of doctors and druggists may be exaggerated. A study published in the Journal of the American Medical Association last week indicates that despite their increasing medical use, the abuse rate for 4 out of 5 of the most popular opioids declined in the years 1990-96, one by nearly 60%.

The message from all this is really painless. As I tell my aching friends, an informed patient is the best patient, and the sooner you speak up, the faster you'll be on the way to recovery.

For more information about dealing with aches and pains, visit arthritis.org You can e-mail Dr. Ian at [email protected]