Question
Hi. I have a relative who lives with intense physical pain due to numerous conditions in her neck and spinal cord. She faces such great pain every day, and has tried numerous doctors and surgeons to help--but finds that they don't take her seriously or realize how severe her pain is, and so they don't give her very many options. They lump her into the category that fits many others looking for help for back pain at the doctor--a group of patients the doctor only gives 10 minutes to, and patients who either come complaining just so they can get pain meds, or who just want the doctor to see they're hurt so the can sue someone, or who just have "aches and pains", or straight up hypochondriacs. None of the doctors give her any real options--all they try is pain medication and physical therapy, which often do not work. She is not suicidal per se, but she feels she cannot live with this intense physical pain every day, and no one is helping her. The pain makes her want to die, but its not that she doesn't want to live, she just doesn't want to live with the pain. She is afraid to say this to the doctor because of the legal ramifications--i.e. the doctor being required to report or commit her...which of course would not help her problem. She needs some doctor to give her other options, surgery, etc., to listen and really try to find a solution...and she doesn't know how to communicate the depth of the pain without being committed for being "suicidal". Do you have any insight on how she can communicate the intensity of her pain to her doctors, so they will take it seriously and take action?  She wants to express her desperation by saying things like, "This pain makes me want to die", "I can't live another day with this pain", "The quality of life I have with this pain every day isn't worth living", "If I have to live with this pain its no life at all", "I can't bear to live with this pain anymore", "Its so bad that it makes me want to kill myself/blow my brains out to get away from the pain"--without fear that they will legally have to have her committed.  Do you have any idea if she can say any of these, without worrying the doctors will institutionalize her? She doesn't know what the legal obligation for them, and what they are likely to report. Please, any help you can give pertaining to what she can say to express intense pain and be taken seriously, would be very appreciated.  Thank you.

Answer
Hi Amanda,
  I am very sorry to hear your relative is suffering in pain. However I am a little concerned how you seem to view others in pain, specifically back pain. You are seriously minimizing their pain while seeming to suggest your relative is not only the only one in real pain but is also in much more pain than any of the others. How is what you are doing any different than what you are claiming the doctors are doing to your relative?

First thing that needs to be done is for them to find out the cause of your relative's pain. They cannot suggest any kind of surgery or other treatments without knowing exactly what it is they need to fix. If they have already found the cause of the pain then it may be something they are unable to fix with surgery. Either way it would probably be best to have your relative consult with a neurosurgeon. A neurosurgeon may know of some surgical option or other treatments that the pain specialists or other doctors do not know about.

If the cause of the pain cannot be corrected with surgery then there are just a few options for your relative to look into. Pain medication is a large part of the standard treatment for uncorrectable chronic pain. If your relative has not gotten any relief with pain medication yet then they have not found one that works for your relative. They should be trying different medications to find one that works. One medication that seems to work for people when other pain medications do not is Duragesic fentanyl patches. They are patches that are worn for 3 days before being changed with a fresh patch. They provide constant, 24 hour pain relief. Duragesic patches contain fentanyl, which is a strong opiate pain medication.

Other options your relative could ask the doctor about are steroid injections that are given at the site of the pain. They are helpful in reducing inflammation and reducing pain. Facet blocks can often be helpful as well as nerve blocks and epidurals.

Telling the doctor that the pain is so bad that your relative wants to die is probably not the best way to communicate with the doctor. Telling the doctor that the pain has reduced your relative's quality of life is one good way of letting the doctor know how the pain is affecting your relative's life. I do not know what the policy is for doctors reporting patients who mention suicide but it very well may fall under doctor/patient confidentiality. Doctors are legally prevented from revealing what is said between a doctor and patient UNLESS that doctor believes that the patient is a danger to others or themselves. Although in this situation it is very unlikely the doctor will report her if she was to say any of the things you mentioned. One tool the doctors use to determine the severity of pain is the pain scale. The doctor asks the patient to rate the pain on a scale between 1-10, 1 being no pain at all and 10 being the worst pain imaginable. I suggest your relative use this pain scale to communicate the level of pain she is in.

I hope this helps. If you have any questions or need additional information please don't hesitate to ask.
          Thanks
              Tracy