Melinda Beck will join Dr. Galati this week to discuss her most recent Wall Street Journal article discussing pain this is discussed in the doctors office. Her column, Health Journal, published this article on July 5, 2011.
A patient walks into the examining room and says, "Doctor, my back hurts and nothing works—except my Percocet." Now, the physician must decide: Is this pain for real?
Despite decades of research, doctors have few tools to measure pain objectively. Generally, they ask patients to rate it themselves from one to 10, or point to the cartoon face on the wall chart whose expression best matches how they feel.
"We don't have a pain-o-meter," says Joel Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor, which draws about 10,000 patients a year, including some of the nation's toughest migraine cases.
Dr. Saper estimates that 15% to 20% of them are faking—or at least, aren't as incapacitated as they say. Some are dependent on painkillers or seeking to resell them, he says. Some want a doctor to certify that they'll never be able to work again and deserve disability payments. Some, he thinks, don't really want to get well because they subconsciously find power in their pain.
Even when pain is real, it's highly subjective. "Two people can have the same nerve compression, but one guy will be bedridden and the other guy will be saying, 'Nah, I'm fine,' " says David Kloth, an anesthesiologist and past president of the American Society of Interventional Pain Physicians.
Evaluating patients' pain is posing a greater dilemma than ever for doctors, given two colliding health-care trends.