We don’t seem to understand it. We are not that good at controlling it. We are becoming better at addressing it. We have a long way to go.
There was a post on My Lymphoma Journey addressing this issue and it really got me thinking.
We are just leaving the declared decade of pain control and research. So, where are we? Pain is now the fifth vital sign. Hospitals, doctors, and drug companies are now more attentive to the issue and attempt to relieve their patients’ agony. There are still areas for awareness improvement. For example: Medicare reimbursement, at some levels, is dependent on functional improvement. Sleep and pain are not considered functional. Therefore, a person can have 9/10 pain while trying to get dressed (after a sleepless night) but as long as they can get dressed independently they do not need treatment.
There are some great new medicines on the market to help with pain control. There are some to help neurogenic pain, such as Neurontin and Lyrica. (Hard to miss all the Lyrica commercials). These are not opiate based. Rather they seem to have their roots in seizure control medicines. They do have their own side effects but can be very helpful.
Drugs, such as oxycodone, are being used to treat everything from acute (new) pain to chronic (long term) pain. It is very powerful and has a pretty high street value. Due to the abuse and over prescribing by many individuals, states are beginning to crack down on its use. This includes more paperwork for doctors. While making sure medicines are used ethically and as intended is very important, especially with narcotics, the increased paperwork and investigations have meant a new barrier to access. Some doctors stopped prescribing it in order to avoid the whole issue. Some pharmacists try to avoid it for the same reason. Who wants to go to jail or lose their license because they did not research their patients’ lives enough. I witnessed a doctor in the hospital accusing a patient of being a wimp and a “clock watcher”. Only to discover later, he just did not like all the paperwork that he had to do every time he prescribed pain medicine.
An issue of particular importance for chronic pain patients is opioid-induced hyperalgesia.
This phenomena involves the person becoming more sensitive. They perceive pain from events and stimuli that normally do not cause pain. Because they feel more pain, they take more medicine. This can make the situation escalate and can be very debilitating. The treatment seems to be to stop the medicines entirely and look at other medicines and non-medicine therapies. There is a brief and good article here. There are some centers that are using a team approach to help these patients. Here is one I found in case you are interested.
What we do not know
What causes pain? I will not go into the science of the chemical and mechanical reasons for it. I am sure that there are whole books on the subject. What is intriguing is that there are people who have x-rays proving advanced arthritis that have no pain. There are people with negative x-rays that are in severe pain. There was a study awhile back that took random people with no complaints of back pain and found that many of them had bulging disks on MRI studies. There have been more studies with similar findings.
So what determines who has pain and who does not? There is so much more that we need to learn.
Best Pain Scale with a twist