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Monitoring

Pain experts recommend getting patients to verify treatment objectives with actual evidence, which could take the form of a letter from a physical therapist or a report from a family member. This evidence-based approach is not foolproof, but it can add considerably to the information provided by the patient. The table below offers some examples of how some functional goals can be verified.

Verifying Functional Goals

Functional Goal Evidence
Walking Pedometer readings or journal
Physical therapy Letter from therapist
Employment Pay stubs
Sexual relations Report from partner
Social activity Report from friend or family member

Source: Adapted from Fishman, 2007.

The goal of treatment is not just to make the chronic pain patient feel better, but also to restore vestiges of normal life. As treatment progresses, a doctor and patient may realize that the bar has been set too high (or too low) for some functional goals. A functional goal that is too aggressive can leave a patient despairing of failure. The pain physician should know that functional goals set at the beginning of treatment can be adjusted during treatment. Many times, a patient resists achieving a goal because it hurts too much. In this case, a physician may reset the goal into incremental steps (instead of increasing pain medication). Treatment for chronic pain is a long-term process that requires adjustments.

Side effects from pain medications, usually opioids, are a constant presence. Nausea, sedation, constipation, and dry mouth are some of the effects.

Reference

Fishman, MD, Scott M. Responsible Opioid Prescribing: A Physician’s Guide. Washington, DC: Waterford Life Sciences, 2007. pp. 53–58.