As a chronic pain doctor I always say this is not in your head and most pain is due to microscopic changes we cannot see. It is essential to say as when most (some docs too) hear “neuropathic” they erroneously think “in your head”
I also make a list of the differential diagnosis/potential causes and how we will rule in/rule out/place in the undecided category. I say “I don’t know” when I don’t. I also say that chronic pain is very hard and there are no easy answers. 2.
I review some neurobiology of chronic pain to explain symptoms, like wind up. I explain pain is like a virus that rewrites wiring. And that emotions are never the cause, but anxiety/depression are like fuel on the fire and you can’t put a fire out while you are pouring gasoline 3
I really try to focus on a holistic approach, so physical therapy, some meds, some procedures, pain psychology (reduces suffering), healthy diet, and pacing. So important. 4
Acknowledge the struggle and set smaller goals. I have no evidence for that. Listen. Validate. 5.
I’m also very clear about limits of imaging, meaning almost always imaging is to rule out things masquerading as chronic pain and not to diagnose the pain. 6.
You can follow @DrJenGunter.
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