How to love chronic pain patients

Pain patients are difficult to treat because doctors want to heal people and chronic pain patients have—by its very name—chronic pain. So says Dr. John Crosby, a family physician in Cambridge, Ont. Here he outlines how he learned to love treating chronic pain patients. Transcript below. Also see: Video: 4 ways to take time off as a physician Transcript Text on page: Dr. Crosby, a family physician of 48 years, recalls that he used to dread treating chronic pain patients. Text on page: We spoke with him in order to learn about how he learned to love them. Dr. Crosby speaking: My name is John Crosby. I'm a family doctor in Cambridge, Ontario, Canada. And I'm an assistant professor at University of Toronto and medicine and Family Medicine at McMaster and Queen's University in Canada. Text on page: How to love chronic pain patients Dr. Crosby speaking: Pain patients are really difficult, because doctors want to heal people, people were taught to do that. And chronic pain patients have by its very name chronic pain, they're not getting better with their pain, you know. 95% of pain we can cure with all kinds of medications and exercise and physio and Chiropractic and acupuncture. But there's a small percentage that nothing works with them. And that's very frustrating for the patient and for us. Text on screen: What changed for you? Dr. Crosby speaking: I went to a lecture many years ago by Dr. Hamilton Hall, he is an orthopedic surgeon from Toronto. He had a really active approach to chronic back pain. And he said, instead of having the patient go to bed, which we all did in those days, he got them right back to work; right into physiotherapy, right back into life. He got them exercising, using their back out walking, swimming, doing everything back to normal life, which was really crazy for us because we thought “This poor guy’s in agony. Why are we making him worse?”, but it actually really worked. Text on screen: What do you prescribe for chronic pain? Dr. Crosby speaking: First of all, I try to prevent chronic pain. So I treat acute pain very, very aggressively: with medications, physio, exercise, everything I can do, I try to get the patient back to work as fast as I can. The worst thing is to take time off work as you just lie around the house thinking about your pain, focusing on your pain. And we all know pain is worse when there's no distractions, like three in the morning when you're lying there you're focusing, but three in the afternoon if you're doing stuff, you forget about it, or it's less than it was. The brain is very huge in controlling pain, I think the brain controls 50% of all pain. Test on screen: What is your tipping point for prescribing narcotics? Dr. Crosby speaking: So my tipping point for narcotics and it's very, very rare, I've only got five patients on narcotics out of 1500. If it's just they just can't function at all, and they're, you know, literally bedridden, then I will use a low dose and slowly go up and try to taper them off as fast as I can. And I get all my patients to a pain clinic. The problem with pain clinics is they're really hard to get into. I mean, it's like a two year waiting list. And then if you're out in rural Canada or rural United States, it takes you even three or four years to get in, there's just so few and their demand is so high. So there isn't a lot of help for family doctors or nurse practitioners or physician assistants with chronic pain. Text on screen: How do you manage the emotional weight of treating chronic pain patients? Dr. Crosby speaking: I schedule the patient first thing in the morning when I'm fresh and alert, you know, I don't have them at five on a Friday night when I'm exhausted and crabby and just want to get home. So my secretary knows that so she puts them in when I'm fresh and I can give them extra time. She'll book a double slot, I book a slot for the spouse, because they need support because they're angry and they feel guilty and you know, so they need support, helping with this patient around the clock. And I do my normal things I do for stress in general you know, which is exercise and eat right and get my eight hours of beauty sleep every night and read books and do things that are not medical. Text on screen: How do you stay passionate about practicing medicine? Dr. Crosby speaking: What really makes me happy to go into the office every day is the challenge--like these patients are a challenge. It's not easy like fixing somebody with an ear infection or a sprained ankle. You have to use all your knowledge, all your empathy, all the other things you've learned your whole life, you know, you really have to get inside their head and show them that you understand them and you believe them because they're used to everybody sort of blowing them off and thinking that they're faking it and making it out and exaggerating. So I really have to go in there and show them that I care about them and I'm going to be there for them.

How to love chronic pain patients

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