It’s often said that a doctor dreads new patients who suffer from chronic headaches. It can be a thankless task – no matter what treatment they are offered, the patients will more often than not return for a new option.
The World Health Organization (WHO) notes that migraine is the third most common disease in the world. It’s also one of the top disabling illnesses; the WHO reports that migraine can be as disabling as dementia, quadriplegia, or acute psychosis. Moreover, migraine has been found to be more disabling than blindness, angina, or paraplegia.
Yet chronic headache/migraine sufferers feel as though they are not being taken seriously, not only by friends and family, but also by the healthcare system.
It’s easy to understand why. This “invisible illness” is chronic, with many often suffering some level of pain on a daily basis. Friends and family long ago lost true sympathy, and sufferers become paranoid that those closest to them may think they are “putting it on.”
It’s also understandable that doctors feel deflated when presented with a chronic pain sufferer. Many have already tried the gamut of treatments from meditation to acupuncture to prescription painkillers. The average person, however, does not have the ability to produce the full lifestyle change that may be required to lessen his/her pain.
As a medical professional, it is important to understand that the psychological effects of chronic pain are as difficult to treat as the illness. Depression often comes into play.
It’s also extremely important for a medical professional to understand the emotional pain that these patients are going through. The fact that there is “no one answer” for treating the illness only adds to the anxiety and hopelessness of the individual. Although a doctor can’t wave a magic wand, he/she can provide the much-needed empathy lacking in the life of a sufferer.
We now get to one of the key issues – the ongoing problem of overdependence on prescription painkillers, leading to the current opioid epidemic. A study in the American Journal of Medicine concludes that around half the people who discontinue abortive or analgesic medications see improvements.
So, however tempting it is to give in to a persistent patient who repeatedly returns for a prescription, that’s not necessarily the answer. Breaking the “rebound headache cycle” may be the right treatment for a patient, but good luck trying to tell that to a despairing individual.
Many headache sufferers have stories of being told by doctors dismissively to “just go off the painkillers.” The physicians may feel they haven’t been dismissive, but a patient is not the best judge of character when distressed and anxious.
If they are open to discontinuing medicine, the best way to convince patients is simply telling the truth – and the whole truth. Don’t sugar coat it. Acknowledge that even the thought of the process they will be going through will be extremely difficult.
These patients will want to know how the process will most likely affect them, and won’t believe you if you say it will be easy. Again, compassion can treat the psychological issues and that, in turn, just may relieve the anxiety level of the patient – which just may help the physical issues.
In the end, there is no magic bullet. It’s hard to find “the right answer” because it is often unique to each patient; it will require the determination of the individual to work with his/her doctor and find out what works best. Whether or not that patient will be persistent enough to work through the options rather than reaching for painkillers is another thing.
What has your experience been?