Pain, pain go away

Pain, pain go away

beingwell magazine Winter 2007
By: Carol Cooper

Pain is usually a perfectly normal, natural and protective response of the human body. Normal pain alerts us to an immediate trauma, such as a cut or burn, warns us to stop an activity or signals an underlying cause that requires medical consultation and, perhaps, a long-term treatment plan.

Sometimes however, pain can be pathological, debilitating and intrusive to the person’s daily life, such as the pain associated with cancers.

Often, once the cause of pain is identified, treatment with commonly known pain-relievers provides adequate, though not always complete, interim relief.

In the event of acute injury or with surgical procedures, the amount of pain may be of relatively short duration but can be quite severe and require stronger, more specifically targeted medications.

These are examples of acute pain and, according to Dr. Michael Sullivan, chief of anesthesiology at Southlake Regional Health Centre, treatment of pain needs to be managed in balance with the overall recovery process.  

With the objective of getting patients back on their feet as quickly as possible, good management of acute pain means administering relief, while incurring minimal side effects —especially those that may interfere with other elements of recovery.

Health professionals have been taught to measure pain on a scale from zero to 10, with zero meaning no pain at all and 10 being the worst pain imaginable to the patient. Taking into consideration the level and the cause of the pain, an appropriate management strategy, specific to the patient can be implemented.

Low levels of pain can often be managed without medications. When medications are required a number of techniques may be used to keep the side effects to a minimum.

Sometimes this means giving a combination of medications. For example, morphine alone, given in the dosage adequate to relieve intense pain, could make a patient so sleepy he or she can’t attend the physiotherapy that contributes to recovery.

By giving a reduced dose of morphine along with another pain medication, such as ibuprofen, the patient feels comfortable enough to get up and about and work towards getting well.

In other cases, patients may receive local anesthetics at the site of their pain or use something called a pain pump.

The pain pump allows patients to administer their own pain medication intravenously as required, at a frequency and with maximum dose as prescribed by the physician.

Exercise plays a major part in overall wellness and, while working towards recovery, many patients benefit from physiotherapy to restore health, manage pain and reduce dependency on medications.

“If someone’s in pain, it’s often because there’s an imbalance at a joint,” says Jennifer Bladon, an outpatient physiotherapist at Southlake. “Something might be weak, something might be too tight, and we use exercise to help balance the problem.”

Warm-water exercise, such as is possible at Southlake’s soon-to-reopen Whipper Watson Therapeutic Pool, helps people with arthritis, those preparing for or recovering from joint replacement surgery, or spinal surgery among other ailments. Buoyed in the 89 to 94 degree water, patients find it easier to move and bear weight. As well, muscles relax and circulation improves, reducing painful inflammation.

Another technique to reduce inflammation used by physiotherapist is ultrasound, useful for those with ailments including tendonitis and ligament injuries. In addition, physiotherapists use massage, stretching and joint mobilization, bracing or traction to manage patient pain.

“Pain can be physical, but we need to acknowledge that pain can also be emotional, mental and spiritual and perhaps a combination of those things,” says Sheila Lewis, an associate lecturer at York University’s school of nursing, who teaches a course in complementary therapies. Many hospitals use some complementary therapies that promote relaxation and improved circulation in conjunction with pain medications.

A certified healing touch practitioner, Ms Lewis uses this as well as as imagery and visualization, music, scents and light massage to induce relaxation. She says relaxation reduces the pain felt by the patient, allowing the body to heal and, sometimes, lowering the need for pain medication.

When pain lasts longer than expected, or is a symptom of an on-going ailment, patients enter the chronic category. Approximately one-third of all Canadians suffer from chronic non-malignant pain, says Dr. Angela Mailis-Gagnon, a professor at the University of Toronto’s department of medicine.

She also directs a clinic for patients suffering long-term pain from a variety of known and unknown causes, including injuries, amputations or nerve damage.

“There is no cookie-cutter (solution) for their pain,” Dr. Mailis-Gagnon said, adding that treatment for chronic physical pain becomes compounded when patients’ emotional wellbeing is also affected. For example, patients may lose their jobs, or their families may break down as a result of their suffering.

Approach to chronic-pain management has to be multidisciplinary, involving professionals of different disciplines and the use of a variety of  medications, local anesthetics, physiotherapy, supportive and psychological counselling. Minimizing side effects while maximizing relief remains the goal of management strategies for chronic pain patients, along with maintaining function and optimum quality of life.

The International Association for the Study of Pain (IASP), is a 6,500-member group of health professionals.

On its first Global Day Against Pain in 2004, co-sponsored by the World Health Organization, IASP president, Sir Michael Bond, said, “Pain relief should be a human right, whether people are suffering from cancer, HIV/AIDS or any other painful condition."

When chronic pain is part of terminal illness, it’s referred to as chronic malignant pain. Then the aim of pain management is to keep patients as comfortable as possible and involves many disciplines, including spiritual counsellors.

“We try to look at pain as a total, which can involve spiritual as well as medical pain,” says Carol Ford, regional clinical program co-ordinator for PalCare Network, an organization of agencies dealing with palliative care in York Region.

Managing pain for palliative-care patients means involving and educating both patients and their families and allaying their fears, particularly of addiction. Pain management begins with the lightest medications possible that incur the minimum of side effects, advancing with the intensity of pain from agents such as acetominophen to codeine to morphine. As with acute pain, combinations of medication are used for maximum pain relief and minimal side effects.

Long-lasting oral medications are used when possible, but if that becomes impossible, patches good for three days take over. Both are often used with shorter-acting medications for breakthrough pain.

Finally, medication can be administered through an injection site under the skin, delivered by a transistor-sized pump. Again, breakthrough doses can be administered within prescribed limits.

“People should have a choice about medications they take,” Ms Ford says. “Sometimes people choose a little more pain and a little less sedation. So, it’s listening to what the patient wants and letting them have that say. We find we always do better in pain management if we allow people (to have a) say in what they want to do.”

As an adjunct to medication, the terminally ill benefit from diversional therapy, Ms Ford says, including music therapy, Reiki, therapeutic touch and even humour. In fact, the Hospital for Sick Children has a resident clown.

Outside clinical settings, alternate and complementary therapies abound to manage the pain of migraine headaches, arthritis, sciatica and many other origins. Regardless of their philosophies or technique, all therapies need to be explained and no reputable practitioner will advise a patient to cease a medical treatment plan or make unreasonable promises about what their therapy can do. A growing number of these therapies are covered by private and employer health plans.

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