Why family physicians need to continually improve at managing pain

Pain is one of the most common things that family physicians hear about from our patients. Whether it’s a visit to specifically discuss a pain-related issue or an “Oh by the way, this has been hurting for a while” statement in a yearly checkup, addressing that pain is an important part of the job.  

The good news is that, of all the medical specialties out there, family medicine is the most well-equipped one to deal with pain. We’re used to doing so with a variety of conditions, and the unique trust our patients place in us helps immensely. But while that experience helps, addressing pain in a primary care setting does have its fair share of challenges, too.  

What patients really want from pain care 

As a family physician who sees primary care patients as well as a practitioner of sports medicine, I see even more pain-related issues than many of my colleagues. One of the things that has helped me—and one thing that I think some family physicians miss—is fully understanding what patients want from their doctors when it comes to their pain. 

We’ve all been there with a patient who waits for months to bring up pain with us.  I ask them about this when it happens. “What made you wait until now to bring this up to me?” Or if we have already started to treat the pain: “What made you wait so long to come back?” And many people say it’s actually their family members who encourage them to get medical help.   

This gets to one of the roots of the issue: Patients want help for pain when it impairs what they want to do. It’s less about discomfort and more about pain as an obstacle to living their life. Many people don’t think of pain itself as a major problem until it gets in the way of their lifestyle or is further exacerbated by doing something they love.  

The other root is that patients want to know and address the “why” behind the pain instead of masking it. They all want to know what's causing their pain. Many patients find their biggest relief in knowing and understanding the source of their pain, because many of them know that their pain might not go away for good. That’s because understanding what may have caused the pain might help them to prevent it from getting worse or to manage it better. 

Those two truths contribute to pain being hard to treat, but it makes it all the more important to do so. 

How family medicine is uniquely positioned to help 

Properly managing pain requires a good relationship, consistency of care, patient knowledge and trust. Those are also the broad strengths of family medicine, which puts us in an ideal position to help. 

The unique opportunity we have in primary care is that we know our patients and they know us. Other specialists are an important part of pain management, too, but the 10-minute interaction our patient has with a specialist they haven’t seen before and might not see again often doesn’t foster trust.  

But, again, we know our patients, and that translates directly to patient care. Our patients may feel more comfortable giving us some of the details and specifics of what they’re feeling, and may feel more apprehensive or careful with other medical professionals or specialists. And we can use our understanding of their work and family dynamics and how that plays into what is affecting them.  

The additional time that we spend with the patient is also crucial for getting a history of the pain, which is so vital to getting to the bottom of it. Was it injury related? Was it overuse related? Neither? What makes it worse, what makes it better and what helps or hurts with swelling? 

Pain management training for family physicians and primary care professionals 

Diagnosing pain and prescribing a treatment plan is more than working through a differential. And no matter how good you are about treating pain, there’s always more to learn and improve. That’s why, when the AAFP researched what family medicine professionals wanted to learn more about, pain management was near the top of the list. 

I’m proud to be on the faculty of the AAFP’s new pain management CME course. This two-day virtual conference takes place on Thursday, May 7, and Friday, May 8. We’ll cover topics like: 

• Fine-tuning clinical decision-making skills 
• The taxonomy and anatomy of pain 
• Ability to differentiate normal variants from clinically significant abnormalities 
• Safer opioid tapering strategies  
• And more 

Additionally, I’m teaching an optional clinical procedure workshop about musculoskeletal exams on Friday afternoon. With the internet and AI so prevalent, a physical exam is one of the areas where we can really provide unique value. In my practice, I can’t tell you how many times patients are pleasantly surprised by how detailed and how well they were examined. They’ve told us how much more comfortable and confident they are after a detailed exam, and so that’s one of the most valuable things I hope my learners take away.  

If you can’t make it to the course, there are other ways to learn.  The Family Medicine Experience is a great place to learn about pain and other topics, and there are plenty of other excellent CME courses to help you continue to improve. 

Depak S. Patel, MD, FAAFP, FACSM, is a member of the Illinois Academy of Family Physicians. A sports medicine expert, Dr. Patel is on the faculty at the Rush University Department of Family & Preventive Medicine.