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Taking Pain Seriously

Published by Chapster on 2004/10/12 (4093 reads)
One of the KEOM Community Focus segments, this article deals with the need to take pain much more seriously than we do, in our life, in the lives of others, professionally, and as a matter of public policy.

Recorded at the KEOM Studios,
October 2002


This is taken from a Community Focus segment that we have once per month with Dr. James Griffin, The Director of KEOM.


Dr Griffin: Hi, Mike! So I understand that we’re talking about pain today?

Mike: Yes, I thought that we’d spend a few moments talking about the kinds of pain that we experience as we age, and really as we go through life. Pain is not always just a physical symptom, but often a deeply ingrained emotional and occasionally spiritual experience. Sometimes, this pain, whether it is physical, emotional or spiritual, bleeds over into another area and the two faces of pain interact - a physical pain becomes very much of an emotional pain.

Dr. Griffin: Can you give an example?

Mike: Yes. Much more than I would like, I visit an elderly person lying in bed, wearing a furrowed brow. I ask her about her pain and she says, “Yes, I’m hurting,” almost in a growl.”Would you like some medicine for it?” “Yeah, but they always make me feel guilty whenever I ask for it. And then they drag they’re feet getting it here.” In this circumstance, the pain is NOT just physical, which could be easily dealt with by medication. It’s also emotional, because her pain is trivialized. She is made to feel guilty for using medications. And, the folks in charge of delivering her medicines seem to be trying to teach her a lesson about how they feel she should handle HER pain! Again, physical pain melds its way into emotional pain. The pain experience is added to because of her fears that she will not be heard or understood or responded to. This leads to the one big axiom that health care givers are supposed to learn about pain: PAIN IS WHAT THE PATIENT SAYS IT IS.

Dr. Griffin: Can you tell me more about that?

Mike: It means that we let the patient tell us how it hurts, we don’t tell them. If they say it hurts terribly, then we believe them that it hurts terribly. Then, we explore how it hurts, where it hurts, and when it hurts and what makes it feel better.

Dr. Griffin: That seems like a simple idea.

Mike: It is. But, there are several road blocks. First, care givers, professionals and family, are busy, often too busy, to stop and hear what the patient is saying. Second, it requires us to set aside our own judgements about what another person is feeling, or should feel. We say, “Well, you received pain medicine two hours ago so you shouldn’t need any now.” Third, it means that we need to set aside our own agenda in order to meet the patient’s needs. Sometimes, that agenda is dictated by a health care provider that is saying, “Move on to another patient.”

Dr. Griffin: So, you’re saying that we really need to understand what the patient is experiencing...

Mike: Absolutely. And, it doesn’t mean that we ignore our own clinical instincts, either. There may sometimes be a drug-seeking part of the way a patient reports pain. But, that component is STILL a part of his or her emotional or physical pain. Lots of times, I have seen this medication seeking behavior GROW because the patient FEARS that his or her pain won’t be treated or taken seriously. So, you get a nurse who comes in, that listens to the patient, makes sure he’s comfortable, and the whole shift Mr. Wally does pretty good. But, as soon as shift change gets near, he starts to get antsy all over again because he fears that his pain won’t be controlled, IF he has any, on the next shift. And that fear is often enough to start the cycle of pain all over again. And, after this cycle has been established over time, it’s hard to get a person to TRUST a caregiver who will understand and deal with the pain.

Dr. Griffin: Is this common?

Mike: Yes, it is very common. In the SUPPORT study of the year 2000, of a group of 4000 patients who died in hospitals, over half of them received insufficient pain control, and about 25% suffered from emotional pain and a sense of social isolation (Rummans, et al., 2000). In long term care facilities, I would say it is even more common.

Dr. Griffin: Well, Mike, what do we need to take away from today?

Mike: That we need to really hear what our loved ones and patients are saying, and that we need to act more definitively to ease the cycle of pain.

Tags: medication   pain   drugs   hurt  

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