Challenges of Chronic Pain

Teenage girl in hospital with therapy dog for chronic pain relief.As a teenager with a chronic disease called Juvenile Dermatomyositis and Juvenile Arthritis, I have chronic pain. Daily pain. I am always in pain at some level.

Chronic Pain Management

I have learned to manage pain pretty well for the most part. First, I try non-medication things like rest, relaxing, stretching, and sometimes just waiting. If that doesn’t work or the pain is more severe, I start with Tylenol or Advil, and I might take something stronger like Tylenol #3 occasionally. I am pretty reluctant to take anything stronger than Tylenol or Advil because a lot of times that can make me drowsy.

During the last five years since my diagnosis, I have had periods of pain that were very severe and affected my quality of life.

Doctor’s Response to Chronic Pain Management

At times, it seemed like the doctors were hesitant to do much to help. Often, the doctor would rearrange my arthritis meds or add an anti-inflammatory and add the wonderful prescription of the “Let’s see how this helps at the next visit” statement. I went through this for month after month without much relief. I felt like I was stuck in a never-ending cycle of waiting without much change.

One day, I started crying at my visit because I was so frustrated by the process. I was tired of having severe pain every day, understandably. Suddenly, after seeing my tears my doctor sprang to action. He ordered an MRI, and he gave me a stronger pain medicine if needed. He also adjusted my arthritis meds again to see if that would help. Then, he surprised me and said that he wanted me to see a back specialist because they might have answers that he didn’t consider. I was so happy to feel heard, but it seemed as if my words didn’t mean very much until he saw physical signs of my pain.

The back specialist did some tests, tried some new meds, and prescribed physical therapy. I am not sure if that will help yet, but I am always happy to try something different if there is a possibility of relief. He did say that there were other options we could try if these original ideas didn’t work.

Pain Spike Events

Unfortunately, I have been to a whopping total of two physical therapy sessions because right after I started, I developed meningitis as a side effect of my IVIG treatment. As if I needed another problem. This was very frustrating because it was my third time experiencing the excruciating pain that comes along with meningitis. It had been 15 months since my last time, and I was starting to hope that we had found a brand that didn’t cause meningitis for me. The first two times I was in the hospital for the meningitis, the doctors managed my pain well, so I was expecting the same this time.

For those of you who don’t know, there isn’t a lot that can be done for aseptic meningitis other than treating the symptoms and waiting. The first time had me in the hospital for 8 days. The second time, I was in the hospital 6 days. I received anti-nausea meds, fluids, anti-inflammatory meds, steroids, and IV pain meds.

This time was a very different experience. The first two days, my pain was managed well. However, once the weekday shift of hospitalists came on Monday, everything changed. I was very nauseated and my pain was not under control at all. I was very frustrated because I kept telling everyone that would listen that I was having severe pain. Also, they were seeing me nauseated, but they were giving me oral pain meds that took too long to work and made my nausea worse.

My Worst Nightmare: A Helpless Victim

One night, a resident came into my room at 3am which was three hours after my nurse called him after I was unable to sleep because of the pain. Finally after hours in pain, I had just fallen asleep when he walked in the room and flipped on all the overhead lights. He then proceeded to shake me awake just to tell me that he couldn’t do anything to help me. As if that wasn’t bad enough, he then made it worse by saying that from what he could see and apparently feel, I didn’t have pain that needed more pain medicine. He then insulted me further by saying that teenagers like to get the high from pain meds and that he didn’t think I needed anything stronger. I tried to explain that the IV meds were what helped last time and that my pain was not controlled like it was the previous two times. He said he couldn’t help.

I felt like such a helpless victim. I couldn’t to anything about it. I couldn’t say what I wanted to say because I was afraid they might treat me differently for standing up for myself. The doctor had complete control over my care and I couldn’t do a single thing about it.

Thankfully, I had a fantastic nurse (Thanks Megan!) who called the charge nurse who contacted the head doctor. That doctor ordered IV meds that helped me relax and get rest and relief that I desperately needed. Not only did he help at that moment, but he also called in the Pain Team.

The pain team is in charge of figuring out how to manage pain and how to find options that you can go home on. Immediately, they put me on a scheduled pain med that was the oral form of what worked for me before, and they also ordered IV dosage in case I needed it in between the oral doses. They ordered a different nausea med that really made a huge difference. Most importantly, they worked with me and came up with a plan to help me feel better. I felt like I could be honest with them and tell them how my pain was doing and what things were working. It was a nice change from being afraid.

Chronic Pain and Pain Med Abuse

I know that pain medicine is a big problem in this country, and I know that many teenagers do take advantage of medications for a high. However, there are many people like me with chronic pain, who would rather nothing more than to never take another medication of any type for the rest of my life. I don’t like the way pain meds make me feel, and I certainly don’t want to take them for “fun.” I don’t understand why they would treat me so badly when I have been a patient there for almost five years, and I have never had IV pain meds except when I had meningitis and maybe one other time when I had something severe when I was newly diagnosed. You would think that they would read my record and see that I am not taking many pain meds. You would think that even if that resident thought that I wanted a high that he would have the courtesy to try to listen in case he was wrong. However, hardly anything follows common sense in the healthcare world.

I have learned a lot from my ongoing back pain and from this hospital stay. You will be happy to know that I was able to be discharged a few days after this incident, and I found it completely easy to return to life without being on IV pain meds. I have learned that I need to try to be as descriptive as I can with the pain and to try to explain how it impacts my life.

Chronic Pain Assessment

I think doctors and nurses can understand better by asking questions that center around how the pain affects your life rather than asking so many pain scale and “describe your pain” questions. Those are very difficult to answer. Almost every time they ask me these questions they go “I know these are hard to answer but try to come up with something.”

I know doctors try to use the pain scale because it’s uniform. 1 through 10 is objective — except when it comes to pain, which is why they always apologize before starting. Instead, doctors could do a much better job of quantifying pain by getting to know the patient and asking personalized questions. Here are some questions they could ask me to determine how much pain I was in:

    1. Could you ride your horse with this much pain?
    2. Could you walk up a flight of stairs?
    3. Could you walk down the hall?
    4. Could you sit at a desk and type on a computer for 30 minutes?
    5. Could you sit at a table and eat a meal with other people?
    6. Is there any position where you can get comfortable for 5 minutes?
    7. Could you sit comfortably long enough to watch a 30 minute TV program?
    8. Do you put off eating a meal or taking medication because the thought of going to get it is too painful?
    9. Does the pain cause you to miss activities or turn down invitations for social events?
    10. Could you play a game for 20 minutes?
    11. If you were exhausted, could you sleep?

What Does Chronic Pain Mean for My Life?

Even though I now feel that I can do a better job of describing how my pain is affecting me in my life, I am afraid of what will happen later in my life if I need pain management. Will it be common to be treated like this? Will I have doctors who listen and that I can trust? Will I find a doctor who I can communicate and collaborate with instead of fear for my care? Do other kids and teens face these same problems?

Please share your pain experience in the Comments below. I’d love to know I’m not alone.

 

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Morgan Gleason is a 16-year-old Patient Experience Advocate who shares her experiences with the healthcare system to inspire change. You can find more from Morgan on her site morgangleason.com and on Twitter @morgan_gleason.

Note: This Perspectives Blog post is written by a guest blogger of DrGreene.com. The opinions expressed on this post do not necessarily reflect the opinions of Dr. Greene or DrGreene.com, and as such we are not responsible for the accuracy of the information supplied. View the license for this post.

  1. Hans de Rycke

    Hi Morgan,
    Food allergy seems to be the main culprit in Arthritis. Less than 45% of the population is lactase persistent. This means for most of us dairy is nowhere as good as previously thought. The body can be allergic to any food; therefore any food allergy is capable of causing inflammation and arthritis. This includes RA, juvenile arthritis, and undefined joint pains. This is why it can be so difficult for one to recognize the relationship between their diet and their symptoms.
    Hospitals, and many MD’s are reluctant to allergy test for good reason.
    Skin testing is inadequate, and many blood tests are not thorough enough to discover a food allergy. The best way to determine if you have a food allergy is to be allergy tested by a competent Kinesiologist.
    Dr George Eisman in his book ‘Vegetarian and Vegan Nutrition’ writes; ‘”Rheumatoid arthritis is more severe than osteoarthritis, is most common in the hands and feet, and is characterized by swelling of joints. Since this type of joint pain can be a symptom of a food allergy, dietary change sometimes has a profound effect. Dairy products, the most common food allergen, are one likely candidate as a contributing causative factor.
    And the British Journal of Rheumatology mentions that; ’43 patients with rheumatoid arthritis, those assigned to a vegan diet had improvement in rheumatoid arthritis symptoms’.
    ‘In systemic arthritis, like Rheumatoid, the cause is coursing through the blood, and it got there through the diet. When all of the joints are involved, the cause is not physical, but chemical. It’s usually casein’. (No Milk, by Daniel Twogood, D.C)
    At 16 years of age you should be old enough to wean, according to Dr Herbert M. Sheldon; ‘It is the rule in nature that the young of each species takes its milk alone. Indeed in the early life of young mammals they take no other food but milk. Then there comes a time when they eat milk and other foods, but they take them separately. Finally there comes a time that they are weaned, after which they never take milk again. Milk is the food of the young. There is no need for it after the end of the normal suckling period. The dairy industry and the Medical profession have taught us that we need at least a glass of milk a day as long as we live. We are never to be weaned but are to remain sucklings all our lives. This is a commercial program and expresses no human need.’
    Good luck to you, Morgan!

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  2. Graciele (@Graciele_Gra)

    This article and tips helped me couple days ago when I was in pain, chronic pain on my jaw due a bicycle accident I was in 4 years ago. My jaw got hurt both sides, and I’ve been having some bad pains lately. This last time the pain was so bad that I had to go to the ER for help, they gave me a shot, but it was not enough to make the pain go away. I was so frustrated, in verge of tears, then I remembered your tips Morgan, on resting and relaxing and tried them while lying in bed… Turns out the pain was gone in a couple of hours after 3 days in chronic pain.

    Thank you Dr Greene and Morgan Gleason for sharing the article and information. It helped me a lot!!

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  3. Sherry Reynolds @cascadia

    Morgan, First of all sorry you had to experience that and more importantly congratulations on being able to continue to get your needs met (and the amazing nurse advocate) despite being put in such a vulnerable position.

    Many many patients in the same situation end up giving up as a form of learned helplessness or worse develop a form of Stockholm Syndrome (where you align with your captors). Hopefully some day patients won’t have to ask, beg or obey to get their needs met and I have no doubt your experiences will help us change not only the individuals in the system but the system itself so that any patient, even those who are too afraid to speak up are still able to have their needs meet.

    Your real world experience coupled with practical solutions is soo valuable to the rest of the community and your poise and intelligence despite the pain are amazing. I hope you have a great rest of your summer and can ride as often as you want to.

    Sherry aka @cascadia

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