A Q+A with Chronic Pain Specialist, Brett Snodgrass
by Brett Snodgrass, FNP-C, CPE, FACPP, Fellow of American Association of Nurse Practitioners
What is chronic pain, and how do I know if I have it?
Chronic pain may mean different things to different people. As a chronic pain specialist and family nurse practitioner, I tell my patients that chronic pain is defined as pain lasting longer than three months on average. So it has to do with the time period during which you experience symptoms, but also whether it has an expected end—most chronic pain does not have an expected end. For example, if you’re healing slowly for months after a surgery, that pain wouldn’t necessarily be considered chronic.
What are the common causes of chronic pain syndrome?
If you’re experiencing any consistent pain, it’s a good idea to talk with your healthcare provider about potential diagnoses. Here are some of the most common conditions chronic pain sufferers have:
- Arthritis, especially osteoarthritis and rheumatoid arthritis
- Joint pain
- Low-back pain
- Results of failed surgery, or multiple surgeries (commonly back and neck)
What should I discuss with my healthcare provider if I have chronic pain?
Treatment for chronic pain will depend on the condition you have, but no matter what your symptoms, there are a few basic facts your healthcare provider needs to know before they can recommend the appropriate treatment options for you. Before taking any medications, be sure you’ve discussed the following with your healthcare provider:
- What risk factors or conditions you have
- What medications or other therapies you’ve already tried
- Which of those you feel worked and which didn’t
- What medications you’re currently taking, including over-the-counter (OTC) medicines and supplements—don’t leave anything out!
What role do over-the-counter medicines play in treating chronic pain?
Some OTC medicines can provide safe and effective relief for mild to moderate pain, but they aren’t meant to treat the chronic pain conditions on a consistent, long-term basis—though they may play a part in a more comprehensive treatment plan for chronic pain. So I often recommend that my chronic pain patients try a combination treatment: safely combining prescription pain medications, neuropathic medications, or SNRIs, when appropriate, with OTC analgesics like acetaminophen, ibuprofen, aspirin, or naproxen sodium.
For example, some chronic pain conditions include inflammation, so while opioid pain relievers are not routine therapy for chronic pain, I may prescribe an opioid pain reliever or another pain medication and an OTC or prescribed anti-inflammatory. But this approach requires that I know and carefully consider the whole patient and urge them to take everything exactly as prescribed, because there are some patients who can’t take anti-inflammatory medicines due to kidney disorders, cardiac disease, or gastric disorders, or can’t take acetaminophen due to liver dysfunction. Everyone’s a little bit different! When it comes to prescriptions and OTCs, everyone should always read and follow the label every time, and, it bears repeating: before taking any medications, talk with your healthcare provider about what’s right for you. You can learn more about OTC pain relievers here.
How do I prevent my chronic pain medicines from getting into the wrong hands?
Diversion of medications is when legally prescribed medicines end up in the hands of someone that the medication has not been prescribed for, to be used for nonmedicinal purposes. Unfortunately, this is a common problem with medicines prescribed for chronic pain like opioids, but there are two easy ways you can help prevent it.
- Safe disposal. Sometimes when you change treatments or you no longer need a medication, you end up with medicines in your house that are no longer needed for the intended purpose. I tell my chronic pain patients that safe disposal is a huge part of preventing diversion, and you can do it right at home by following these four easy steps:
- Take medication out of the packaging and remove and shred label.
- Mix medicine with an unpalatable substance such as kitty litter, dirt, or used coffee grounds.
- Place the mixture in a container such as a sealed plastic bag.
- Throw the container in your household trash.
You can learn more about safe medicine disposal here, including other options like disposal programs at local pharmacies where available and community take-back days.
- Safe storage. For the pain medicines you’re still using, always keep them stored up and away where someone who’s looking for medicines can’t find them. The best place is in a medicine lockbox, which can be purchased at your local pharmacy. You never know—unfamiliar people and regular guests who come to your house may be looking for medicines.
Brett is a Family Nurse Practitioner and Certified Pain Educator practicing at LifeLinc Pain in Memphis where she is the Director of Clinical Operations. She is also an award winning healthcare blogger (TheNPmom). Brett is board certified with the American Association of Nurse Practitioners (AANP), where she is currently the Tennessee State Representative. She is also a member of the American Academy of Pain Management and Sigma Theta Tau. Brett is a national faculty and clinical expert for U.S. FDA Long-Acting Risk Evaluation and Mitigation Strategy education initiative, CO*RE. She received the AANP State Excellence Award for Tennessee for 2015 for her work across the state on the TN Chronic Pain Task Force, as well as advocating for TN Full Practice Authority for Nurse Practitioners. She is married with two teenage daughters.