From a PA Who Treats Chronic Pain Every Day
Chronic pain is complicated — and navigating pain management can feel like an uphill battle. As a physician assistant in pain management, I work with patients every day who are frustrated, tired, and often misunderstood.
Most patients don’t get a behind-the-scenes view of how providers think or why certain decisions are made. So today, I’m pulling back the curtain.
Here are five things your pain management provider wishes you knew — but might not have said out loud.
1. We want to help you — but we have rules we must follow.
You may feel like we’re gatekeeping medications or dragging our feet on treatment approvals. The truth? We’re often bound by strict DEA, CDC, insurance, and clinic policies. That means we can’t always prescribe what you want, even if we agree it might help.
We spend a lot of time navigating red tape — not because we don’t care, but because we have to protect you, ourselves, and our licenses. A big part of pain management is working within the system to get you the best care possible — and sometimes that means taking longer routes.
2. Pain management is a partnership — not a quick fix.
We’re not here to “cure” you — and we know you’ve probably heard that before. But pain management works best when we treat it like a long-term relationship with shared goals. We need your input, honesty, and consistency just as much as you need our expertise.
If you’re open-minded, communicative, and willing to engage with different strategies (not just medications), the chances of improvement are much higher. Chronic pain is a puzzle — and we’re trying to solve it together.
3. We’re trained to look beyond the pain score.
You might be asked, “What’s your pain on a scale of 0 to 10?” But we’re also paying attention to:
- How you walk into the room
- Your facial expressions and body language
- Your mood, sleep, and activity levels
- How your pain affects your function — not just how it feels
This helps us create a functional pain plan, not just treat a number. We want to know: What can’t you do because of your pain — and how can we help get that back?
4. Urine drug testing (UDT) isn’t about trust — it’s about safety and legality.
Yes, we know it feels invasive. But UDT is a legal and medical requirement in most pain clinics, especially when opioids are involved. It protects both you and us by confirming medication adherence and checking for dangerous combinations (like unprescribed benzos or fentanyl).
A surprise result doesn’t mean we assume the worst — but we do need to have honest conversations about it. Being upfront from the start helps us support you better and avoids misunderstandings.
5. We see your pain — even when it doesn’t show on a scan.
Not all pain shows up on MRIs or X-rays. Nerve pain, soft tissue disorders, and central sensitization are all real — and often invisible. Just because imaging is “normal” doesn’t mean your pain isn’t valid.
You deserve to be heard and believed. Our goal is to treat the person, not just the pictures.
Final Thoughts
Pain management isn’t perfect. It’s layered, personal, and often frustrating — for both patients and providers. But when you have a care team that listens, explains, and works with you, you can regain control over your life.
If this post resonated with you, stay tuned. I’ll be covering topics like:
👉 How to talk to your provider about pain
👉 The truth about opioid contracts
👉 Natural and alternative options for chronic pain
👉 Navigating disability, FMLA, and medical documentation
Until then, know that you’re not alone — and you’re not broken. There is hope. There is help. And there are people in your corner.
Let’s keep moving forward — together.
— Krystin Navarro, MMSc, PA-C, MSL-BC
Living Well with Pain 