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When Your Body Hurts… Fears, Myths & the Truth about Pain Agenda What is pain How many people have it What causes it Barriers to effective treatment Assessing & treating pain Consequences of unrelieved pain Where to get more information What Is Pain?

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when your body hurts

When Your Body Hurts…

Fears, Myths & the Truth about Pain

agenda
Agenda
  • What is pain
  • How many people have it
  • What causes it
  • Barriers to effective treatment
  • Assessing & treating pain
  • Consequences of unrelieved pain
  • Where to get more information
what is pain

What Is Pain?

“Pain is what the person says it is and exists whenever he or she says it does.”

-Margo McCaffery, RN, MS, FAAN

1968

clinical definition of pain
Clinical Definition of Pain

“…an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

  • International Association for the Study of Pain

In other words, pain is any sensation that hurts.

types of pain
Clinical Type

Nociceptive

Neuropathic

Duration

Transient

Acute

Chronic

Breakthrough

Types of Pain
common words used to describe pain
Stabbing

Dull

Aching

Throbbing

Cramping

Gnawing

Squeezing

Sharp

Burning

Shooting

Numbness

Tingling

Common Words Used to Describe Pain
how many people have pain

How Many People Have Pain?

“…within the past year three in every four Americans surveyed (76%) either personally have experienced chronic or recurrent pain themselves or have a close family member or friend who has suffered from chronic pain.”

-Research!America, 2003

pain in vulnerable populations

Pain in Vulnerable Populations

“Whatever affects one directly, affects us all indirectly.”

-Dr. Martin Luther King, Jr.

December 1967

pain tends to occur more often in vulnerable populations
Pain Tends to Occur More Often in Vulnerable Populations
  • Racially, ethnically & culturally diverse
  • Women
  • Children
  • The poor
  • The elderly
barriers to effective treatment

Barriers to Effective Treatment

“Human health does not depend only on treatment by physicians. Social & political circumstances profoundly influence the health & well-being of all people.”

-American Academy of Pain Medicine

Ethics Charter, 2003

structure of the healthcare system
Structure of the Healthcare System
  • Low priority given to pain
  • Access Issues
  • Cost Issues
regulatory barriers
Regulatory Barriers
  • Laws, statutes, rules, & regulations
  • Regulatory scrutiny of pain practitioners
  • Law enforcement issues
healthcare professional barriers
Healthcare Professional Barriers
  • Knowledge
  • Attitude
  • Practice
patient family barriers

Patient/Family Barriers

Common Concerns

Myths and Fears

Associated with Pain

myths and fears about pain
Myths and Fears about Pain
  • Pain is inevitable
  • Pain cannot be relieved
  • Increased pain means disease is getting worse
  • Taking strong medicine early means fewer options later
  • Strong pain medicines cause addiction
myths and fears about pain18
Myths and Fears about Pain
  • Pain with incurable disease cannot be controlled
  • “No pain, no gain”
  • Reporting pain will distract from treating the disease
  • The medical team will know about my pain
  • The medical team learns a lot about pain in school
in search of treatment

In Search of Treatment

“Reflection on the meaning of pain and the meaning of nursing\'s responsibility to respond to pain is a challenging endeavor.”

-Betty J. Ferrell, PhD, FAAN

assessment tools
Assessment Tools
  • Brief Pain Inventory
  • Memorial Symptom Assessment Scale
  • Edmonton Symptom Assessment Scale
  • M. D. Anderson Symptom Inventory
  • Numerical rating scale
  • Visual analog scale
  • Wong-Baker Faces Scale
visual analog and numeric rating scales

Visual Analog Scale

No

pain

Worst

possible

pain

Numeric Rating Scale

0

1

2

3

4

5

7

8

9

10

6

No

pain

Mild

pain

Moderate

pain

Severe

pain

Visual Analog and Numeric Rating Scales
methods for managing pain

Methods for Managing Pain

“In the depth of winter, I finally learned that there was within me an invincible summer.”

-Albert Camus

knowledge
Knowledge
  • Accurate information
  • Good resources for learning the facts about pain & its treatment
  • Understanding your role
medical interventions
Medical Interventions
  • Medications
  • Procedures and Surgery
  • Non-drug interventions
    • Physical therapy
    • Psychological approaches
    • Integrative approaches
  • Chemotherapy / Radiation therapy
medicines to control pain

Medicines to Control Pain

Long & Short Acting Medicines

Side Effects

Concerns about Safety

long short acting medicines
Long & Short Acting Medicines
  • Long-acting medicines
    • Are used for on-going, constant pain
    • Provide constant pain relief around the clock
  • Short-acting medicines
    • Are used for breakthrough pain
      • Intermittent pain that “breaks through” regular pain control plan
side effects can be controlled
Side Effects Can Be Controlled
  • Constipation
  • Nausea & vomiting
  • Drowsiness
  • Confusion
  • Respiratory depression
concerns about safety
Concerns about Safety
  • Pain medications are most safe & effective when taken
    • By mouth whenever possible
    • By the clock
    • When pain is still mild
    • As prescribed
pain medicine breathing
Pain Medicine & Breathing
  • Pain elevates metabolism
  • Pain medicines are usually increased in strength & amount gradually prior to high doses of strong opioids
  • Opioid medications rarely have significant effects on breathing in patients taking opioids for cancer pain
concerns about addiction
Concerns about Addiction
  • Addiction is a disease characterized by
    • Impaired control over drug use
    • Compulsive use of drugs
    • Continued use of drugs despite harm
    • Craving for drugs
physical dependence means
Physical Dependence Means
  • The person is dependent on the drug & will experience withdrawal symptoms
    • If the drug is discontinued abruptly
    • The dose is reduced too rapidly
tolerance means
Tolerance Means
  • The person has adapted to the drug so that over time the person needs to increase the dose of the drug to get the same benefit
pseudoaddiction
Pseudoaddiction
  • When a person seeks pain medicines for control of persistent pain
    • May display “drug-seeking” behaviors (early refills, requesting higher doses of opiates)
  • Reflects inadequate pain control, not addiction
    • “Relief-seeking, not drug-seeking”
complementary therapies for managing pain

Complementary Therapies for Managing Pain

Mind/body Therapies

Physical Therapies

Movement Therapies

Nutritional Approaches

self management strategies do work
Self-Management Strategies Do Work
  • Usually easy to learn
  • Enjoyable to do
  • Effective when used regularly
  • Provide a sense of control
  • Can involve family or other loved ones
  • Can be combined with medicines
work w trained professional on your own
Need Professional Help to Learn or Do

Biofeedback

Self-hypnosis

Guided imagery

Massage

Acupuncture

Progressive relaxation

exercises

Practice on Your Own

Heat/cold application

Music

Distraction

Rhythmic breathing

Work w/ Trained Professional & on Your Own
consequences of unrelieved pain

Consequences of Unrelieved Pain

“Pain is a more terrible lord of mankind than even death itself.”

-Albert Schweitzer, MD

unrelieved pain means major lifestyle changes for 20 of americans
Unrelieved Pain Means Major Lifestyle Changes for 20% of Americans
  • Employment
  • Residence
  • Personal freedom
impact on daily life
Impact on Daily Life
  • Severe pain can prohibit even the most basic activities of daily living
    • Bathing
    • Dressing
    • Toileting
    • Eating
  • Persistent pain can alter mood & immune function affecting both mental & physical health
increasing pain results in decreased activity and impaired quality of life
Increasing Pain Results in Decreased Activity and Impaired Quality of Life

Cleeland, C.S. (1989). Measurement of pain by subjective report. In: Chapman CR, Loeser JD, editors. Issues in Pain Measurement. Advances in Pain Research and Therapy, 12, 391-403. New York: Raven Press.

what you can do to help the person with pain
What You Can Do to Help the Person with Pain
  • Be present
  • Believe reports of pain
  • Communicate
    • Healthcare providers & treatment professionals need to know if treatment is not effective
  • Advocate
    • On behalf of your loved one
    • For people with pain everywhere
  • Vote
for more information
Alliance of State Pain Initiatives

(608) 265-4013

http://aspi.wisc.edu/

American Cancer Society

Toll free: (800) ACS-2345

www.cancer.org

American Pain Foundation

Toll free: (888) 615-PAIN (7246)

http://www.painfoundation.org/

Texas Cancer Info

www.texascancer.info

[email protected]

Texas Pain Advocacy & Information Network

www.txpain.org

Texas Partnership for End-of-Life Care

www.txpec.org

Texas Pain Society

http://www.texaspain.org/

For More Information
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