Monday, February 23, 2009

Pain Management

Some health care practitioners do not understand modern pain management. My father, whose brain tumour caused him to lose his language, was unable to name his pain. I had to name it for him in a poem. It is one of the failures most regret: advocating hard enough until it was treated and managed took me months. Not a cost issue, we were paying for most of his medications, staff hesitated to manage his pain.

You can read pain symptoms in the body language and the spirit of those we love. Caregivers, professionals, need to listen to us.

Such publications as The Fundamentals of Hospice Palliative Care (2007) speak of pain as a "complex biological event that affects the person, the family, the community, and society." When a loved one suffers, we all suffer. It is up to a family member to advocate for those who cannot speak for themselves. Sometimes deep pain, as affected by psychological, biological, sociological, spiritual or practical factors, can increase without interventions.

Early intervention ameliorates pain. Prevention is a good manager. Pain experiences are related to cultural backgrounds, gender, the personal meaning of pain, and one's life experiences.

Barriers to treating pain:
  • personal, preconceived prejudices on the part of the patient, health care professionals (PSW, nurse, physician, institution), caregivers, family members
  • myths around pain management - that it is 'normal'
  • myths around dosages
  • myths around delivery of pain relief - oral vs. shots
  • myths around addictions, dependence, tolerance

Recognizing pain early, predicting pain and preparing for it is essential. There are two kinds of pain: acute and chronic.

Chronic pain lasts for 3 - 6 months, and one has to adapt to it in various ways. It comes and goes, and endures longer than the expected time for healing or disease. It can be exacerbated by
  • anticipatory pain - fear & anxiety causes the expectation of pain
  • incident pain - resulting from being moved, or moving, changing positions, or dressings
  • remembered pain - related to previous experiences, similar to PTSD that causes a reaction deep in the brain
Acute pain has a definite pattern of onset, caused by many physical issues. It causes the fight or flight reaction, dilation of pupils, sweating, faster heart and breathing rates. It needs to be addressed quickly and with a comprehensive approach.

No one person will have the same pain threshold as another. This is a fatal error health care professionals can make. Pain threshold can be raised by
  • discomfort
  • insomnia
  • fatigue
  • anxiety
  • fear
  • sadness
  • depression
  • boredom
  • introversion
  • social situation
It can be lowered by:
  • symptom relief
  • sleep & rest
  • sympathy, understanding, companionship
  • diversional activity
  • elevation of mood
  • anti-depressants, anxiolytics, analgesics
Complementary therapies
  • acupuncture
  • art
  • breathing - e.g., childbirth - Lamaze training
  • chanting
  • dream work
  • imagery
  • insight therapy
  • massage
  • meditation
  • music
  • homeopathic remedies
  • prayer
  • reflexology
  • relaxation
  • therapeutic touch
  • yoga

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