Why Chronic Pain Isn’t Just in Your Body (or in Your Head)

In 2023, the CDC published a report showing that an estimated 20.9% of US adults experienced chronic pain. That's over 51 million Americans. This burden of pain significantly contributes to our health care costs, lost productivity and, let us not overlook, personal suffering.

It's not all about the capitalistic burdens of health care costs (which BTW are born by us as individuals), nor the lost productivity for industry: it's about the personal and familial impact, highlighted by those who think that their pain is a personal shortcoming.

You may very well be asking yourself why a pediatrician with a focus on emotional health is talking about adult pain, and I'll be honest: your question is simply because we have learned to look at pain the wrong way. And there is a paradigm shift happening, available for more to hop on. Let me explain with a very poignant example:

Yesterday I received a community referral from a local mental health colleague who knew I am a physician with a mantra, "My goal is to never write another prescription again." 

Mrs. A came to see me and shared that she suffered from chronic pain and just didn't want to take any more medicine for it. They never lasted. She didn't want to be needing medicine. She was over it, and also over all the questions about how the pain was all in her head. She wanted help. Could I help?

I asked her: "When do you experience pain?"

"When I'm stressed," she quickly replied.

I expanded, "Tell me about your stress."

Now mind you, I had no idea where this pain was in her body, and I asked nothing about the quality, location, duration... in fact, I had been taught back in medical school to focus on the PQRST of pain (now expanded to include the O): 

• O: nset: When did the pain start? 
• P: rovocation/Palliation: What makes the pain better or worse? 
• Q: uality: What does the pain feel like (e.g., sharp, dull, burning)? 
• R: egion/Radiation: Where is the pain located, and does it spread anywhere? 
• S: everity: How bad is the pain on a scale (e.g., 1-10)? 
• T: iming: How long has the pain lasted, and does it come and go? 

The only thing I asked about was to clarify when the pain is experienced, but not leaning into the description of the pain, but more about the environment/contributors. We needed the context for the pain.

Why?

Because when we get all the nitty-gritty about OPQRST, it's about focusing on the pain.

She had already told me what's causing it, as well as what the relief would be: Stress Relief.

Within the first 3 sentences of our conversation, she had already told me what the real problem was. It was time to focus on that.

So I kept asking her about her stress,

• what was it like?
• when did she feel it?
• where in her body did she feel it?
• what did she do when she felt it?
• When is a time that it is so much better?

And it all came back to relationships within her family. Her family has a lot of chaos and strains within the relationships. There are children with behavioral concerns, adults who had their own forms of behavioral challenges - lots of drama - and remarkably, every time my new friend received an incoming call from her adult child, the stress shot through the roof: tension, anger, irritation, pain.

"It sounds like your stress is related to your family."

"Absolutely," she said. "In fact, I feel completely normal when they aren't bringing all their insanity around me. And when I'm reading my books."

-- Insert quick discussion about these books that she pointed out the irony that they were not what anyone would consider stress-relievers: Stephen King, dramas, intrigue. -- 

Back to her family:

"Do they live with you?"

No.

Fascinating. 

For once I didn't actually ask my famous question (aka What do you need?), I took a darn good guess:

"It sounds like you need a break."

Her entire body relaxed. She exhaled.

Bingo.

"It sounds like you like drama when you can close the book and put it down for a while."

"Yes, I need a break. I need to keep my peace and not let them steal it. I don't need pain medicine. I need quiet."

Our conversation continued for just a few more moments, ending with big thanks and big hugs. And let's be honest: when I say that my goal is to never write another prescription again, that doesn't mean not practicing. It means shifting practice. It's no longer the traditional medical-model.

There is nothing broken. There is nothing to fix.

And there is everything to listen and understand.

We are taught in medical school, "The patient always tells you the answer," and it is 💯 true. The problem is that medical school also teaches us how we are the experts in medicine, healthcare and while that is also 💯 true, it overlooks one key thing:

Each and every one of us is the expert in our own lives. We have our own answers and our own needs. Those needs, BTW, just happen to be emotional. And we have not been taught enough about engaging in conversations about emotions, needs, and the intersection where we constantly find ourselves of how our emotions drive our behaviors and our health.

Just one quick look at the Surgeon General's health advisories and you can see the pattern: emotions are woven throughout each and every one of the "epidemics" and health struggles faced by each and every American.

We have emotional needs. Overwhelm, loneliness, fear, shame - they are all calling for connection, which is the opportunity to completely change our experience. It's not a fix. It's an opportunity to heal.

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Curious what changes when emotions lead the way? What if they’re not the problem—but the path? Let’s talk about how a prescription-free, connection-first approach will reshape what matters most—in your family, your work, and your life. https://WendySchoferMDScheduling.as.me/lets-meet-up-45