Managing Pain Properly - No Matter What Age

Everyone experiences pain at some point in their life, be it the sudden (acute) pain from a bad cut or a broken bone or the chronic pain of a back injury or migraines, just to name a few causes. Acute pain is generally well treated because it is usually caused by something you can see (a cut, a surgical incision, a broken bone), and many analgesics (pain relievers) are meant to handle the pain. Chronic pain, however, can't be seen clearly, can't be identified easily, and certainly can't be treated easily. But is it because it *can't* be treated, or because it *isn't* being treated. There are arguments for both sides.

Throughout my work as a nurse, I saw pain (mis)management for many patients. Rarely were the patients over medicated - they were much more likely to be undermedicated. This happens for many reasons, the most common ones being:

• The person assessing the pain is using his or her own thoughts of pain as a measuring stick as to how painful a certain situation should be.
• The person assessing the patient doesn't see the patient acting in a way that he or she feels a patient in pain should be acting.
• The analgesics prescribed are not effective for the type of pain the patient is experiencing.

Not only did I see it in my professional life, I've seen it personally as well, most recently over this past weekend. My mother fell over a week ago and broke her ankle. Then we were told it was her hip too, now we are back to "just" her ankle. The thing is, she has other chronic problems - in particular a badly damaged back - that cause a lot of pain so at home, she was on a constant dose, every day, of a pain reliever that kept her pain at bay. Once she was admitted to the hospital, this constant pain reliever was discontinued because the doctors needed to assess her overall health.

After a few days of very severe pain, she was prescribed a patch of a medication called fentanyl. It's a great (in my opinion!) way of delivering medication, because the patch goes on your skin and delivers a constant dose of analgesia for three days. There is no up and down of pain reliever levels in your blood, it is always there. After three days, it needs to be replaced, but it is a simple procedure of removing the old patch and applying the new one.

In my mother's case, she had to have the patch removed the same day she was going to surgery for her ankle, so she didn't have a new patch put on. This was Saturday. I went in to see her on Sunday and she was in a lot of pain - more than just post-surgical pain at her ankle, her back was very, very painful. I wasn't sure why, so I looked for her pain patch. She didn't have one. She should have.

I went to speak to her nurse who was puzzled that I would be asking for a pain patch - she said that she would have it again in three days, when it was time for the next switch. I explained to her that she had no patch at that time - nothing. No pain relief other than the short acting acute pain reliever they were giving for her surgical pain. The nurse didn't seem to understand my argument. I kept saying, the patch should have been put back on - it wasn't put back on. It doesn't make sense that my mother (or any patient) should have to wait three days because that is what the medical record said. The medical record is assuming that she had HER PATCH ON.

After much discussion, the nurse said she would call the pharmacy (of the hospital) to see what she should do. Sure enough, she was in my mother's room within a half hour with a new patch for her. When we asked her why my mother hadn't been receiving this pain relief for her chronic back pain, the nurse answered something to the effect of "here we are only concerned with the surgical problem, not her other ones." What?

So, what was wrong with this picture? A lot.

We have an 82-year-old lady who is in a lot of pain from the new fracture and from the old back injury. She has been taking long-term pain medication for years, so her body is used to a certain level of analgesia in her system. This chronic pain medication was taken away from her and not replaced. Therefore, she was in much more pain than she had to be. Because the nurses couldn't be bothered with learning about all of my mother's medical issues, they didn't understand why the chronic pain medication (the patch now) was vital for her recovery. If you are in pain, you can't do your rehab exercises, get out of bed, or even think of getting better. Then the cycle began. Because the nurses didn't understand why her chronic pain relief was necessary, she didn't get it. Because she didn't get it, she had more pain....

Pain is not something that can be ignored, regardless of the cause. A patient who is having pain cannot heal properly. The amount of energy it takes to deal with pain is taken away from the energy needed to heal.

I will be discussing this issue with the hospital once everything has settled down. I do have to say, I was absolutely not impressed with the cavalier attitude of someone who wasn't in pain regarding someone who was.

Healthier Children Through Play

There are words of gloom and doom all over the media these days: Our children are out of shape, lazy,  fat, and developing adult lifestyle-related illnesses, such as type 2 diabetes. And, what is even more frightening, for the first time, this new generation may actually have a shorter lifespan than that of the generation before. Is it all this serious? Is this just a Chicken Little "the sky is falling" subject? Unfortunately, the answer is, yes, it is this serious and no, it's not a Chicken Little scenario.

According to the Nemours Foundation, one out of three American children are overweight or obese. In Canada, it's estimated that 26% of children are overweight or obese. This isn't just a few children. This is millions of children in North America whose health is at risk.


So, what is causing the problem? Why are so many of our children so overweight? Unfortunately, it's not just one thing. Of course, diet is a major issue - generally children who eat well-balanced and healthy portions of meals don't have a weight issue. But our society pushes high calorie, high fat, processed foods because everything has to be done fast, be ready, and convenient. And these are generally not the health choices. The other main culprit for the child obesity problem is lack of exercise. If you don't exercise, use your body, you can't burn off excess calories. Not only will the weight come on, the muscles won't get strong and the whole body suffers.


Is There Time for Play?


"But there's no time for play," you may say. Between the children being at school (sometimes with rather long commutes), at daycare, at music lessons, doing their homework, and so on, where will they find the time to be active?


It used to be that children had plenty of active time at school. Between the recesses in the morning (and sometimes afternoon), plus the play period after lunch, children had the opportunity to run around the school yard, play tag, toss a ball, and just be free to have fun. Unfortunately though, recesses are being cut back in some schools. There's even talk of eliminating them in some places. In addition, many schools use recess as a punishment. If a student doesn't behave or hasn't done her homework, for example, recess is taken away - effectively eliminating any chance the child has for burning off any energy and experiencing social interaction beyond that of inside classes.


Playing at home outside after school isn't an option for many children. They either live in parts of the city where they can't safely play unsupervised; they're in daycare or after school care, so not at home; or there isn't anyone else around to play with them because either the neighborhood children are not allowed the freedom to play outside or they are themselves in daycare.



Another opportunity for exercise used to be from getting to and from school. Children would walk back and forth or ride their bikes. That's not a common sight these days. Parents are often seen driving their children to school even if they only live a few blocks away. For some parents, it is a matter of convenience - they're dropping off their children at school while on the way to work, but other parents don't want to walk (or bike) with their children and they certainly don't trust their children to go alone. The result: no exercise for either child or parent.


Finding the Time for Play


It may seem rather simplistic to say that all we need to do is find the time for children to play, but it could be as simple as that. However, finding the time itself isn't always the easy part. In order for each family to decide that they need to exercise more, allow their children more freedom in what they play and when, the family has to find out what is preventing the play time. If it's because the children have too much homework, this is an issue that should be brought up to the school. If it's lack of space, you may have to look for available play space. If it's time, then scheduling play time, free time, needs to become a priority. Our children are not as healthy as they should be and allowing them to play, to run, to enjoy being children is actually a good way to improve their health. Isn't it worth the investment?

To read about games that we used to play as children and some blog posts and article on playing, visit GamesWeUsedToPlay.ca. 

Games We Used to Play

Every generation says the generation before is different - and this isn't usually meant in a good way. The older generation complains that the newer one doesn't have the same work ethic, doesn't have the same respect for elders, and so on. Now, whether that is true, I can't say, but I do know that the children of today, in North American society, often do not have the same opportunities for free play that we did. This, to me, means they are missing out on something vital, something important in their development.

When we played for hours with our friends, without adult supervision, while we were having fun, we also had to make rules, enforce rules, mediate problems, and sometimes learn to deal with things that just weren't fair. These are all tools that we took with us into adulthood. Was it fair to always be picked last for a team? No, of course not. Is it fair when the child with the ball takes it home because he feels that he wasn't being treated with enough respect? Again, of course not. But much of this was negated by the fun of playing hours long games of tag and hide-and-seek, without being told to be careful, watch what you're doing....

There is a lot of research going on into the importance of free play and it is quite interesting. To encourage discussion of the subject, I have started a website called Games We Used to Play: A Hop, Skip and Jump Down Memory Lane.

The goal of the site is to gather as many stories of games from across the world as we can. One person from one country may post they played a certain game one way, but someone else may recognize it as a game they called a different name and they played with slightly different rules. I am also adding articles about different issues about free play and I encourage people to comment on them, to add their point of view.

Games We Used to Play also has a Facebook page, where we can share more information, and we are on Twitter, at @gamesweusedtopl.

Support Your School Nurse - Even if you don't have kids.

School nurses play a vital role in our society and most people probably don't even give them a second thought - unless they are thinking about the "cushy" job they may have. Those who think this may be surprised to learn that the school nurse they may remember from the childhood is long gone and the school nurses of today are in a specialty all its own.

In an article I wrote for GE Healthymagination This Isn't Your Mother's School Nurse, I talk about the many issues that school nurses face that they didn't exist a generation or so ago. School nurses are dealing with sick or disabled children who, years ago, would never have been able to attend a school or who may not have lived to school age.

School nurses also have to deal with children who may rarely, if ever, see a doctor or nurse practitioner outside of school. The children may either have no health insurance or may be in a family situation that doesn't allow for preventative health care. School nurses also have to deal with the realities of this generation, which include coordinating and running disaster plans for events such as natural disasters, crime and terrorism. They need to deal with children who are abused or neglected, as well as those who are homeless. And there is so much more.

It was very interesting to speak to the two nurses I interviewed for the article. There are statistics that show that schools who have nurses, particularly full-time nurses, have better attendance rates. We know that if children go to school regularly, they have a better chance of graduating and moving on to further education or finding good, productive work out of high school. School nurses do the actual nursing tasks that teachers and administrators have to do if there are no nurses - and in this day and age of education cutbacks, we can't afford to have teachers doing non-teaching work.

So, please, support your local school nurses. They need to be part of the core group of professionals students encounter at school every day. Having a school nurse is not a luxury. It's a necessity, whether you have children or not.