The Urgency of Chronic Pain: Common Excuses – Past Disappointments

By | October 11, 2011

Just as Pavlov was able to extinguish negative operant conditioning with positive reinforcement, we can overcome the effect of past disappointments with compassionate care and effective treatment.

As we alluded to in the last blog most of the patients who come to see us have seen other pain management physicians before, often several. In addition most have been treated for several years by their primary care physicians and other specialists before being referred to pain management. Most physicians feel no sense of urgency in treating chronic pain, because, well it’s chronic.

What this kind of attitude and treatment represent is a systematic indoctrination of the patient into a culture of failure. In Pavlovian terms we have conditioned the patients to expect failure. “After all if the last six guys couldn’t help me, why should I believe that this doctor will?” This kind of negative operant conditioning is extremely difficult to extinguish, but it can be done. Similarly in medical school we were taught to be careful about how we interacted with pediatric patients, because if one doctor lies to them or hurts them, they may never be able to trust another physician again. Adults are not so different.

This is probably the most important reason that I approach each and every patient with a sense of urgency. If a patient is willing to sacrifice a large portion of their day to come and see me, it must be important to them and it should be just as important to me. If a patient has been neglected, mistreated or abused by previous physicians, it is imperative for me to show them that those types of behavior will not be tolerated here, because I know that if cannot rebuild trust, I cannot succeed in treatment.


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