CHRONIC PAIN - DEFINED - (pain
scale)
- Pain
that goes from bad to worse to unbearable
yet is consistent in it's presence.
- Pain
that lives with you every day of your life, never
ceasing, not even long enough to get a
night's sleep, can be one of the worst things
about having lupus.
- Because
lupus primarily affects women, I found it
interesting that the National Institute of Health
(NIH) noted that
women report more severe and chronic pain than
men,
and urged doctors to factor sex into
diagnosing, treating, and researching
chronic pain management.
- The
NIH Revitalization Act of 1993 mandated that
women and minorities be included in clinical
research.
- Previously,
pain research had been male-oriented because:
The alleged rationale has been that the
estrus cycle in women would confuse the results
(?!)
- It may be true that women
react to pain differently than men do.
- If pain may 'arise
differently' in women, then more research is
needed focusing solely on chronic pain in women!
- Simply
ignoring women's pain is not a viable solution,
and more therapies for the relief of
chronic pain must be found.
- The
first line of defense against chronic pain in
inflammatory diseases like lupus and arthritis
has always been pharmacological.
- Non-steroidal
anti-inflammatory drugs (NSAIDs), such as aspirin
and ibuprofen (Advil or Motrin) have been used to
treat mild cases on short term, with
success.
- For
more intense pain that does not respond to
NSAIDs, narcotic analgesics such as
continuous/sustained release meds, may be
used long term.
- However,
for some patients, with chronic pain, the long
term and addictive effects of narcotics
may be too much for them to be used on a daily
basis and over the course of time with the
already established debilitating effects of their
illness, chronic lupus.
This
is where Alternative Therapies have stepped in:
Pain
relieving techniques like hypnosis and magnetic
stimulation therapy have given
patients a non-medicinal alternative that
may be more beneficial in the long term.
It is
known that a patient's cognitive and emotional
state
can influence their physiological system.
Changes
in their physiological state can affect their
overall function.
This
intimate mind/body relationship can be used to
treat painful states via hypnosis.
Enhancing
the nervous systems inhibitory process can
modify pain.
Hypnosis
can induce a state of relaxation, calmness and
peacefulness even in the midst of external
distress.
This
temporary state of calm can effectively reduce a
patient's subjective experience of pain.
Why would
any clinician want to use any procedure that must
be explained and justified to the
traditional world of medicine?
Such as massage, chelation therapy, homeopathics,
herbal preparations.
Because they can work.
Not always in a spectacular fashion
and likely not with every patient
and certainly not with every condition,
But it can and does work individually, as has
been shown over time.
Perception
of pain is as individual as each person.
What
works for one person may not work for another.
It may be
helpful for the person living with chronic pain
to experiment with different therapies.
It is
advisable to start with the least invasive, or
least expensive, therapies and go on
from there.
Try using
ice packs before taking medication, and try
medication before seeing a surgeon.
The
main thing to remember is that no one needs to
suffer needlessly, and to keep looking until you
find the pain relief that works for you.
ALTERNATIVE
MANAGEMENT
Physical Agents can all be
helpful with individual patients,
under the right circumstances.
heat
pads
cold,
ice packs
exercise
massage
immobilization,
rest
use
of TENS units
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PAIN SCALE
Levels
of Pain FROM 0 - 10
0 Pain
Free
1 Very
minor annoyance - occasional minor twinges.
No medication needed.
2 Minor
Annoyance - occasional strong twinges.
No medication needed.
3 Annoying
enough to be distracting.
Mild painkillers take care of it.
4 Can
be ignored if you are really involved in
your work, but still distracting.
Mild painkillers remove pain for 3-4 hours.
5 Can't
be ignored for more than 30 minutes.
Mild painkillers ameliorate pain for 3-4
hours.
6 Can't
be ignored for any length of time,
You can still go to work and participate in
social activities.
Stronger painkillers reduce pain for 3-4
hours.
7 Makes
it difficult to concentrate and
interferes with sleep
You can still function with effort.
Stronger painkillers are only partially
effective.
8 Physical
activity severely limited.
You can read and converse with effort.
Nausea and dizziness set in as factors of
pain.
9 Unable
to speak.
Crying out or moaning uncontrollably - near
delirium.
10 Pain
level actually makes you pass out and to become
unconcious. Pain management is a must at
this point!
PAIN MYTHS
Severe or chronic
pain cannot be effectively controlled.
Opioids are always
addictive and a treatment of last resort.
Pain is always evidence of
disease progression.
It is more admirable or socially
acceptable to ignore pain.
Pain is an unavoidable result of
aging or disease.
Pain is a deserved punishment.
A patient’s pain perception
can accurately be correlated with vital sign changes and
evidence of injury.
Patients in pain readily express
their pain to health care providers.
Patients of certain cultural,
ethnic, or socio-economic backgrounds consistently
under-report or over-report their pain.
Opioids are addictive and a
treatment of last resort because of unmanageable side
effects.
Patients experiencing chronic
pain over-report pain because they are addicted to
opioids.
Older patients, and cognitively
impaired patients do not perceive pain as intensely as
other patients.
If a patient is able to sleep,
they must not be in very much pain.
The goal of chronic pain
management is to keep the dose of medication as low as
possible.
Patients with a history of
substance abuse who require IV opioids should never be
allowed to control their own dose of
medication/analgesia.
There is no physiological basis
for the moderating effects of emotions on pain
perception.
PAIN
FACTS
The patient is the best
authority on his own pain.
It is very important to know and
recognize the patient’s physiological,
psychological, and emotional responses to pain when
developing a pain management plan.
Without addressing these important issues, it is often
difficult to develop an adequate pain treatment plan.
Changes in vital signs do not
occur with all patients who are experiencing severe pain.
Do not rely on vital signs to determine the severity of a
patient’s pain.
Patients with pain, even severe
pain, can be distracted from thinking about their pain,
and may even be able to sleep.
Don’t trust that a patient isn’t having pain
because he "looks comfortable."
Always ask, and believe the patient’s assessment of
his own pain.
The patient has the right to
expect a rapid and effective response to a complaint of
pain.
Treat the pain, reassess
frequently, and continue to treat until the patient is
comfortable
or side effects prevent further treatment.
If this occurs, consult a pain expert- don’t leave a
patient in pain without a treatment plan.
A history and physical
examination of the pain is very helpful.
Details of the pain’s location, duration, radiation,
and character often provide
valuable clues about how to treat the pain most
effectively.
Medications are best given
orally for long-term management of pain.
For short-term management, like
postoperative pain, the IV route is preferred (especially
with acute/severe pain).
Most pain medications have side
effects.
Effective pain relief is often accompanied by at least
some of their stated side effects.
Be prepared to treat the side effects of opioids if they
occur (e.g., nausea or itching).
A balanced approach to pain
management combines non-pharmacologic and pharmacologic
therapy, and frequently utilizes multiple analgesics
which work by different mechanisms.
Chronic pain
patients are usually on a specific regimen of
pharmacologic and nonpharmacologic therapy.
This regimen must be continued during their
hospitalizations.
Additionally, super-imposed acute pain or acute
postoperative pain, should be treated with additional
opioids.
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