When Chronic Pain Is Personal

Working with chronic pain has become a way of life for Richard Brasington, MD, FACP, professor of medicine and rheumatology fellowship program director at the Washington University School of Medicine, St. Louis. He first experienced back pain in college 45 years ago and now, at age 65, has degenerative disk disease, severe spinal stenosis and severe compression of the fifth lumbar vertebra. Chronic musculoskeletal problems have led to arthritis and nerve pain. Prior to having back surgery two years ago, he relied on a lot of pain medication to function. Although he had significant improvement following the surgery, his symptoms have now returned, and he’ll need to schedule another surgery.

Richard Brasington, MD, FACP

As someone who lives with chronic pain, Dr. Brasington can relate to many of his patients in a variety of ways, such as having a love–hate relationship with narcotics. “Like my patients, with all of the emphasis on the potential problems associated with taking chronic narcotics, I have worried that my doctor may not refill my pain medicine,” he says.

“This experience has made me realize how vulnerable patients are,” Dr. Brasington continues. “When they have severe pain, they are very dependent on their physicians and are at our mercy.”

On the other hand, although pain medication relieves his symptoms, it also makes him feel terrible and irritable. “I once told my wife that I wanted to throw all of my meds down the toilet, which in retrospect is something that my patients say,” Dr. Brasington recalls.

Effects on Work
As a physician, Dr. Brasington believes sharing information about your health with patients is a very personal decision. Depending on how well he knows a patient, he may share information about his condition. “I’ve seen some patients for 20 years,” he says. “Often, before I ask patients how they are doing, they ask how I am doing or how my wife—who has rheumatoid arthritis—is doing,” he says.

He goes on to say, “Although I talk about my ailments quite a bit, I don’t think anyone should feel pressure to discuss anything they aren’t comfortable with. My patients often seem surprised to learn that I have a musculoskeletal condition. I think it helps me to connect with them because they can see me as a patient, as well.

“When a patient is concerned about taking pain medication, I may mention that I have a back problem, that I take pain meds and that I’m aware of the potential problems,” he says. “I say this to make the patient more comfortable with taking [medications] or to help me to make a point.”

On a bad day, Dr. Brasington has found himself saying to certain patients, “I’m sorry, but I’m having trouble following what you’re saying. My back really hurts today, and I just took some medicine, so I am really fuzzy headed,” he recalls.

Coping with Chronic Pain
As someone with chronic pain, Dr. Brasington has had to come to grips with having a condition that will never go away. He suggests patients find some comfort in the fact that pain management medications can help them cope.

The acceptance factor is another component. “Although physicians tell patients they must accept having a disease, it’s a lot harder to actually do it. But I can say I understand, because I have a chronic problem, too,” he says.

But for Dr. Brasington, having to accept living with a chronic condition isn’t as difficult as dealing with a family tragedy that occurred more than a decade ago. To cope, Brasington has had a conversation with himself that went something like: “You have to accept that this happened. I don’t like it, and I can’t change it. But it has happened.

“The only way to move forward is to accept it,” he says. “And if I can accept this [loss], I can accept other things I don’t like.”

Editor’s note: Since publication of this article, Dr. Brasington has had spinal surgery scheduled for late January. We wish him a speedy recovery!

Karen Appold is a medical writer in Pennsylvania.