Tuesday, October 9, 2012

Three Issues Interfering with Pain Management

I was invited to give a talk about chronic pain and stress to university students in an elective psychology course. I'm in a unique situation in that I have experience with pain, acute and chronic, from different angles. As a health writer, I have interviewed experts who research pain and those who treat pain, and I've spoken with people who live with it. As a nurse, I've helped and counselled patients on managing acute and chronic pain and, as a patient, I've experienced a good bit of pain as well. So, I accepted the invitation and began to think about what I was going to say.

In my mind, there are three main issues that need to be addressed before anyone can even begin to talk about how to manage pain:

1 - Pain is misunderstood.
2 - Pain is mistreated or undertreated.
3 - Pain is considered to be a weakness.

Pain is misunderstood

This is a big one and a precursor to the following two. There is a lot of research going on in the field of pain. Scientists can tell you about pain pathways and brain reactions, but actual pain is still not understood. We all have our own perceptions of pain and healthcare professionals are no different.

I get migraines. Unfortunately, it was when my children were young that I experienced the most migraines. My migraine pain was a drilling, knifing pain behind my left eye that went unabated as no medications would touch it. So, as a mother of young children, as many parents did, I had to manage and do what I could through the migraines.

One evening, my oldest son had basketball practice and anyone who has ever gone to a basketball practice knows what it is like - between the bouncing balls, the whistles, the shouting and the stampeding feet up and down the gym - it's anything but quiet. I'm not sure why I brought him, but there must have been no other option. I remember, very clearly, sitting on a bench along a wall wishing this would be over very quickly when a dad looked at me and asked if I was ok. No, I replied. I'm not. I told him I had a migraine and I felt awful. He looked at me and said very matter-of-factly, "You can't have a migraine. If you had one, you couldn't be here."

In my haze of pain, I couldn't bring up the energy to argue with him, it took all I had to just be there. But here was the perfect example of how my pain was misunderstood. Because this man may have experienced migraines that incapacitated him or he knew of someone who would be out for the count, he could not fathom how someone else could work through the pain.

And it's not just the everyday person who does this. A medical professional who doesn't feel that you look like you're in enough pain to satisfy his or her perception of how you should be acting may not be willing to give you the benefit of the doubt.

Pain is mistreated or undertreated

Some physicians are reluctant to order narcotics or opioids for pain relief and some nurses are reluctant to give the medications because of an irrational fear that the patients will become addicted to the medications. As a result, pain that would respond to the opioids goes untreated. I've seen situations when I worked in palliative care with patients who were dying of cancer, and their family members specifically said that their loved one was not to be given any opioids because they didn't want them to become addicted.

Research has shown that if a pain is responsive to opioid analgesia (pain killing) and the medication is taken appropriately, the chances of becoming addicted to the medications are remote. The body uses the pain killing properties of the medications and there is nothing to become addicted to.

What may happen is the body may begin to tolerate the medication, requiring a higher dose. This is NOT the same thing as an addiction. The human body becomes used to many types of medications, making it so that higher doses are needed to achieve the same effect. (Fear of Addiction: Confronting a Barrier to Cancer Pain Relief)

Sometimes pain doesn't respond well to the first-choice pain medications that are suggested or prescribed. There are a variety of reasons for this, ranging from how your body metabolizes the medications to the type of pain you have. Some pain will respond much better to an anti-inflammatory type of analgesic than another type. Unfortunately, it can happen that rather than trying different medications or formulations, the dosage or frequency of a medication is just increased, still not solving the pain problem.

Pain is considered to be a weakness

Think about people who are admired. People may be in awe of the athlete who breaks his ankle but still continues to play, the coworker who has dental work without anaesthetic, or the friend who refuses pain medication following surgery. They're tough! They're strong! This, of course, implies that people who take medication, who complain about pain, aren't strong. They're weak.

We have pain for a reason, usually. It's a warning that there is something wrong, that we need to stop doing something or we need to do something to stop what is causing the pain in the first place. The athlete running on the broken ankle? He may be doing permanent damage that can't be fixed and may end up living with chronic pain for the rest of his life. The friend who doesn't take medication following surgery may end up with a much slower recovery, even complications like pneumonia because she can't get up and about as readily as her roommate who is taking regular doses of pain killers.

Pain is not a weakness and needing treatment for the pain is not a sign of being weak.

These three issues can and do make it difficult for many people who have pain to manage it properly. They can't get people to understand that they hurt. They may have trouble finding a healthcare professional to help them and if they try different doctors or clinics, they may be labeled as "doctor shopping" and may have an even more difficult time finding help. And they may not be able to confide in their friends and family, asking for help, lest they be considered weak.


Alison said...

As someone who has lived through severe, chronic pain that was way undertreated, I could not agree more!
Also, this stoic attitude towards pain also reminds me of people who go to work when sick. WHY?? You'll just make everyone else sick.
PEOPLE: if your body says "no" listen to it! No brownie points for ignoring it.

Marijke Vroomen-Durning said...

It seems so obvious, doesn't it? I was always a huge advocate of proper pain control even before it became a real issue with me. I don't understand why some people feel that pain is something that we just have to live with. why? What's the point?

Jennifer Fink said...

You are so right, Marijke. Another issue that I see -- related to yours -- is the tendency of some healthcare professionals to become jaded, to lump ppl into the "drug seeker" category. Yes, there are ppl who hop from ER to ER, looking for drugs. There are also ppl who have chronic pain who go from doc to doc looking for reliefe. Sometimes, they may be the same ppl. Either way, you can't negate the fact that they may have pain.

I also think that some healthcare professionals get frustrated -- if they can't find a "cause" for the patient's pain, or adequately treat it, they tell or imply that there's something wrong with the pt. The attitude is, "you must be making this up," instead of, "I've reached the limits of my knowledge and expertise. Let's find someone else who can help you."