As we age, we all get back pain at some point. So how do you know when it’s time to see a doctor about it?
The answer is usually “right away.”
Many people think that pain clinics are only for chronic pain but the truth is, if you see a doctor when your pain is acute, you may be able to keep it from ever becoming chronic.
So what’s the difference?
Acute, subacute and chronic
Acute pain is defined as pain that lasts for less than three months. If your pain lasts from three to six months, it’s subacute. If it goes on for more than six months, your pain is chronic.
Say you bend over to pick up your toddler and you throw your back out. A week later, it still hurts – that’s acute pain. If it still hurts in seven months, your pain has become chronic.
That’s a simple explanation, but in reality, it’s not exactly that simple because most people don’t treat acute pain – they ignore it.
Say you bend over to pick up you toddler and you throw your back out. You’re busy – you’re a parent, you go to work, you run errands, you have a yard to keep up with, and the pain will go away on its own eventually. So you ignore it.
It makes sense in a way, because no one considers back surgery the day after a minor injury, so why bother seeing a specialist? But it keeps hurting and you keep ignoring it.
Seven months later, you’re in agony all the time, still ignoring it as best you can, trying to keep up with your daily schedule, but it always hurts and you’re willing to do anything to fix it. You’d even consider surgery at this point; you don’t care, you’re just miserable. So you see a specialist.
It’s been seven months — is your pain chronic now?
It’s really not, because you spent more than six months not treating it. I consider your pain chronic if you’ve spent six months trying to treat it but it still hurts.
But what if you had just gone to the doctor a few days after it had started hurting?
Treating it right away
That’s what we’re trying to get people to do; go to the doctor as soon as they’re hurt. I can usually see a new patient within two or three days of their call and with minimal effort, I can keep acute back pain from becoming chronic.
In some cases, it’s as easy as prescribing a stretching routine. Stretching loosens up the muscles and joints and can correct many types of acute back pain. In other cases, it takes an injection or an anti-inflammatory medication but regardless, treating it sooner rather than later will usually keep a small problem from becoming a big one.
Rate your pain
The pain scale almost all physicians use is the VAS, or visual analogue scale. I don’t particularly like this type of measurement, but it’s generally required by insurance companies so we use it, along with more comprehensive measures of pain.
The VAS is a measure of pain intensity that is essentially “on a scale of zero to 10, how much does it hurt?” Zero means you have no pain at all, while 10 is the worst pain you can imagine. It’s an easy way to talk to patients but there’s a reason doctors don’t like it: because anyone who’s ever been in chronic pain knows that the “correct” answer is eight.
That’s because doctors and nurses aren’t allowed to give narcotics to patients who report pain below seven or eight. If you are in the hospital and a nurse asks you to rate your pain, if you say “eight,” they’ll give you some type of pain medication. If you report that it’s anything below seven, they’ll tell you to wait awhile. So if you’re hurting and you want help, you’ve probably learned not to think too hard about what the number really is – your answer is probably always “eight.”
We use the VAS because we have to, but we’ve got a better measure.
How much better are you?
At Integrative Pain Specialists, once we start treating a patient, we ask “in percentages, how much better are you than at your last visit?”
If a patient says they’re 25 percent better, we know things are improving well. What we really do though, is watch how they move and pay attention to how they hold their body – experienced doctors can tell a lot from little cues in posture and movement.
Between asking the question and observing, sometimes we might think they’re underestimating. If a patient says they’re feeling 25 percent better but they’re moving really well and don’t seem to be hurting, I might ask them “are you sure you’re only 25 percent better? You seem to be feeling even better than that.”
Often the answer is that the patient is much better than that, but doesn’t want to be “kicked out” of treatment. The truth is, we never kick anyone out of pain management treatment. If a patient is doing well and feeling better and wants to continue treatment, we’ll continue seeing them for life if they want to keep coming in.
What to expect when you visit a pain specialist
The first thing to consider before making a call to the pain specialist, is who the pain specialist should be. A pain doctor is not legally required to have done a fellowship in pain management, but they really should. So first, check to be sure your doctor has done a fellowship in an accredited pain management program. That accredited fellowship ensures that not only did your doctor get additional training in pain management, but they had to be good enough to be accepted into the program in the first place.
Then, make sure your doctor provides integrated pain management, not just prescriptions.
Any good practice will be checking you out as well. At Integrative Pain Specialists, we usually only take referrals from doctors. That’s not a hard and fast rule, but it helps us to ensure that patients are serious about treating their pain, not just looking for narcotics.
Of course we do take cold calls. For instance, if you call our clinic and mention that you’ve read our blog, we’ll know that you understand our commitment to pain management over pills. The reason we are careful about new patients is that we spend a lot of time with each new person, so we only see about 10 new patients a week. When a person finds us through the Internet and is just shopping for pain pills, they’ll be disappointed to find that we won’t help them; and we’ll have given up an appointment that could have been used by someone else.
Of course, we aren’t opposed to pain pills and we do prescribe them, but there are better options that should be tried first. And before anything else, always remember that acute pain is simpler and easier to treat than chronic pain. Call us – or your primary care physician – as soon as it starts to hurt. Seeing a doctor within two days will save you a lot of pain and trouble in the coming months.
Benjamin Seeman, DO is the head physician at Integrative Pain Specialists. Board-certified through the American Board of Physical Medicine & Rehabilitation with a fellowship in pain management, Benjamin specializes in osteopathic techniques and integrative therapies for managing pain. He has been voted Richmond Magazine’s Top Doc since 2012.