“therapeutic switching,” involves substituting a cheaper drug for the one your physician prescribes.) “This is an increasingly common problem,” Fine says. “Insurance companies are looking for every possible reason not to pay.” Even a generic version of a brand- name drug (which has the same active ingredients) sometimes isn’t as effective, says Hahn. WHAT YOU CAN DO: If the pharmacist hands you a prescription for a drug you don’t recognize or your doctor didn’t prescribe for you, ask why. If you find out it’s because your insurer won’t pay for the origi- nal drug, consult with your doctor to see if there are other options that are covered. If she concludes that you really need the original prescription, ask her to call the insurance company and lobby directly on your behalf. Also talk with your provider about oth- er options, such as nondrug approaches like acu- puncture, physical therapy and exercise. If you think you might qualify for a drug-assistance program based on your income, check out Needymeds.org, or the Partnership for Prescription Assistance (pparx.org), which is run by pharmaceutical companies.
REASON
Too many of us have adopted a “pop-a-pill” mentality.
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If only treating chronic pain were as simple as taking medication. And drugs do definitely help in many cases, but they typically aren’t a magic bullet. “Drug therapies are at best a component of an overall ap- proach to managing pain. All of the evidence to date suggests a multidisciplinary approach to pain [works best],” Fine says. “It takes a team.” That team might include your primary care doctor or pain specialist, plus a physical therapist, nutritionist, acupuncturist or stress management pro. Experts say it’s generally best if pain is attacked on multiple fronts: exercise, diet, rehab, massage, relaxation and lifestyle modi- fication, with medication typically an important part of your pain-care plan as well. After Candy Pitcher broke her back in an accident, she was reluctant to go on long-term morphine. “I had to overcome my fear of taking a narcotic,” says Pitcher, 56, of Cary, North Carolina. “I thought that’s what drug addicts take.” Her husband and family also were concerned about her using such a powerful—and stigmatized— drug. But after trying various other therapies that didn’t help, including acupuncture and Feldenkrais, and educating herself about opioids, Pitcher is now more at ease taking the medication. “This is what works for me,” she says. “Morphine is a life-saver if used correctly.” But she uses nondrug approaches as well. The other mainstay of her treatment is daily
journaling about the challenges of dealing with chronic pain. “It gives me the opportunity to get it outside of me, to let it go,” says Pitcher. WHAT YOU CAN DO: Explore all your options. Then work together with your healthcare providers, doing your part to help yourself. “Patients really need to be participants in their pain management,” stresses Rollin Gallagher. Be open-minded and willing to try different approaches until you find the ones that work for you. Some of the most effective and safe nondrug options for many pain conditions include physical therapy, massage, hot/cold compresses, stretching, yoga, biofeedback and stress management. Keep in mind, too, that your drug regimen may need to be tweaked over time if what you’re taking doesn’t work. Talk to your doctor if you think you may need a higher dose, or a different medication altogether.
REASON
You think suffering is normal, or something you need to “power through.”
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Some simply prefer the stiff upper lip approach to pain control. Everything, from your gender, age and ethnicity to your upbringing and even your religious beliefs, can play a role in how likely it is you’ll seek help and commit to a treatment plan. Research has found, for instance, that African-Americans are less likely to report pain than whites; men tend to under- report discomfort more than women; and the el- derly are less likely to complain about their aches than younger generations. But ignoring the issue isn’t likely to make it go away—in fact, this may only make the problem worse by allowing the pain to become more severe and harder to treat, requiring stronger drugs to get it under control. WHAT YOU CAN DO: As a chronic pain patient, you’re already likely facing sizeable challenges in getting good care, especially if your pain is severe, poorly controlled or otherwise hard to manage. So it would be a real shame to stand in your own way, right? Start by helping yourself: Learn more about the condition(s) causing your pain and about the pain process itself. Become your own best advocate, says Candy Pitcher. “Keep searching until you find the right doctor for you, keep an open mind and look to the future.” Above all, stop believing that suffering is just a part of life. While most chronic pain suffer- ers won’t experience 100 percent relief, the great majority should be able to see enough improvement that they can regain function and enjoy life again. Adds Rollin Gallagher, “Patients should not accept that they have to live with pain that’s disabling.” PR jacqueline stenson is a writer based in Los Angeles.