Is it too much to ask that we, the patients, no longer be bound to a system where no one professional takes responsibility for the patient—a system of unbelievable referrals with unscientific, unproven treatments (and hope) sold to the patient by each referring physician. In many cases, patients end up worse and more and more destitute, yet they grasp for hope with each referral.
—A chronic pain advocate2
Numerous factors—involving the type of pain, one’s background and personal traits, and the family and social environments—affect an individual’s treatment plan. In many different cases, especially for people with complex, chronic pain conditions, biopsychosocial care (taking into account patients’ unique biologic and genetic constitution, their psychological and emotional composition and reaction, and the societal and environmental framework within which they reside and function) has been shown to be advantageous. In all cases, a trusting relationship between patient and clinician fosters clear communication intended to improve outcomes.
Steps in Care
When confronted with pain, some people seek professional help early on, probably from a primary care clinician, while others attempt, at least initially, to handle the situation on their own. If the pain persists, however, affecting physical functioning and quality of life, a person is likely to seek treatment—and should do so—in case the pain is functioning in its warning role as described in Chapter 1.
At least initially, a clinician probably will assume pain is a symptom of some underlying condition and prescribe analgesics, while focusing on discovering what the underlying problem might be. But if a cause cannot be found, if early treatments fail to bring improvement, and if pain persists for several months, it may progress to the point where it becomes a disease in itself, that is, an abnormal condition that impairs or disrupts normal bodily functioning (this is almost always chronic pain). Then, regardless of the initiating process, cause, or underlying disease, the clinician must focus on management of the pain condition in order to assist in restoring the individual to a better state of health. This is not to
2 Quotation from submission by Peter Reineke of stories from the membership of patient advocacy groups.