Everyone with health related problems can use a doctor as an ally. This is especially true for people with chronic pain. At their best, doctors can provide good management, appropriate referral, emotional support and advocacy. But chronic pain patients are frequently managed poorly and marginalized. How can this be?

Doctors are highly trained professionals and most have a sincere interest in helping their patients. The problem for chronic pain patients is that most doctors receive little or no formal training in the management of pain. Many are afraid of turning their patients into drug addicts and coming under the scrutiny of regulatory bodies or the police. Pain management is not a medical specialty formally recognized by any official certifying organization in Canada. There is often resistance on the part of private or public health insurers to accept the significance of chronic pain. These factors combined with our inadequate understanding of the mechanisms of chronic pain can present seemingly insurmountable barriers to care for chronic pain patients.

In my practice one of the most common emotional reactions among patients is anger. Many feel that in addition to their pain, they have to carry the burden of convincing others that they are hurting to the point of not being able to function properly. Given the very real above-mentioned barriers to care that they face, they feel misunderstood. They are.

As justifiable as anger may be, all too often it only makes things worse. The physiological results of anger are like those of pain and fear. In other words anger is just one more thing that can aggravate pain and worsen distress. Angry behaviour may alienate people who might otherwise be helpful. There is no question that venting anger may provide temporary satisfaction and relief but does it really help in the long run? If anger clouds judgment, how can good decisions about dealing with chronic pain be made?

Many of my patients have every reason to be angry. Those who practice meditation/relaxation techniques are learning to free themselves from being controlled by their anger. The same techniques form the core of our chronic pain therapy group. The way to learn to use doctors has to include reducing anger so it doesn’t worsen pain or get in the way of obtaining help.