Chronic Pain: Are You Receiving Adequate Treatment?

Chronic pain is any pain that persist longer than the expected healing time, this can be anywhere from three to 6 months. It can be due to orthopedic, nerve, cancer, arthritis, or other long-term chronic diseases. Healthcare personnel train for utilizing the pain scale which the patient is asked to rate their pain from 1-10, keeping in mind that pain is subjective and not objective. Everyone has the right to effective pain control regardless of the healthcare professional's personal beliefs. Unfortunately, although pain management has a psychological component to it, some physicians will deem a person's pain as psychological only, especially if they cannot find a definite reason for continuing pain. Many physicians are concerned over the possible addiction to pain medications. These beliefs are unfounded if pain actually exists.

Subjective pain derives from the sufferer's beliefs, view, and opinions, no one else can feel your pain or sensations. Objective pain derives from a view, which the treatment team will agree on and considered more factual and certain. Objectivity can be measured or quantified by anyone using the same tools and resources. Someone can view your records and medical conditions and opine that you should not have chronic pain; this is an objective conclusion. Many physicians rely on just their objective conclusions, even refusing to offer certain medications, while their patients suffer with chronic pain. Sometimes physicians refer patients to a psychiatrist when they do not believe the patient is really in pain. I have first hand experience with this approach; the doctor stated it was "all in my head."

Healthcare professionals utilize a scale to rate pain from 1-10 or faces showing expressions of pain from mild to severe. As a registered nurse, I have to admit that I found this scale difficult for me to use; it is a matter of interpretation between both parties. Frequently the physician does not inquire on other qualifying and useful questions such as onset of pain, intensity, location, any radiation, alleviating and precipitating factors.

According to Singh (Oct 2005) "patients with several psychological syndromes (e.g., major depression, somatization disorder, hypochondriasis, conversion disorder are prone to developing CPS" (chronic pain syndrome). This is not to suggest that chronic pain is more psychological than physiological. It only indicates the necessity for a multidisplinary team approach of healthcare providers, including a pain management specialist, psychologist, psychiatrist, physician, and physiatrist. Chronic pain can have devastating effects on one's physical, family, social and work life, even worsening of psychological symptoms if not effectively treated. Each modality contributes to your care in order to provide the best pain management.

Physicians must screen each patient for a predilection for narcotic abuse, including family and psychological history. There is a difference between taking a narcotic to relieve pain and taking it to get high, especially if you take the medication as prescribed. Some pain may never totally dissipate but treatment can make it tolerable and improve quality of life and daily functioning.

It is important to understand the difference between addiction, dependence, and tolerance. According to Meadows, (June 2004), "addiction is characterized by craving and compulsive use of drugs. Physical dependence occurs when a person's body adapts to the drug. If someone has become physically dependent on a drug and suddenly stops taking it, then withdrawal may occur. These symptoms can include muscle aches, watery nose and eyes, irritability, sweating, and diarrhea." Physical dependence is a normal response to repeated use of opioids (such as Percocets, Vicodan, Morphine, and Oxycontin) and is distinct from psychological addiction. (Meadows, 2004). Unfortunately, because of the few that abuse and/or sell their pain medication, physicians are more hesitant to prescribe certain narcotics; patients who would benefit from those drugs are not successively treated. Good communication with healthcare professionals is the key to effective treatment.

There are many resources on the internet for chronic pain suffers, such as the National Chronic Pain Society, and American Chronic Pain Association. These resources also discuss non-narcotic treatment of pain and the stress it can produce.

References:

Singh, Manish, MD. (Oct. 2005). EMedicine: Chronic pain syndrome.

www. Emedicine.com

Meadows, Michelle. (June 2004). www.FDA.gov